Most common dermatologic problems identified by internists, 1990-1994

BACKGROUND: Internists in all settings see many patients with skin conditions. Thus, their education in dermatology is important. Information on which areas of dermatology are most commonly seen in internal medicine practices is necessary for designing effective educational programs on skin disease. OBJECTIVE: To determine what types of dermatologic problems internists most commonly diagnose. METHODS: National Ambulatory Medical Care Survey data from 1990 to 1994 were analyzed for dermatologic diagnoses. Physicians specializing in internal medicine and all its subspecialties were compared with dermatologists and with other physicians. RESULTS: The most common skin disorders diagnosed by internists were dermatitis (15.8% of all diagnoses) and bacterial skin infections (14.0% of all diagnoses). Combined, bacterial, fungal, and viral infections included 28.3% of the most common dermatologic diagnoses made by internists. The top 10 most common diagnoses accounted for 57.9% of all skin-related diagnoses and the top 20 most common diagnoses accounted for 72.8%. Internists were more likely to see patients for bacterial skin infections, herpes infection, exanthem, urticaria, and insect bites while dermatologists more commonly saw patients for actinic and seborrheic keratoses, warts, benign and malignant skin tumors, and psoriasis. CONCLUSIONS: The most common dermatologic diseases diagnosed by internists differ considerably from those diagnosed by dermatologists. Because dermatologists do much of the dermatology teaching of internal medicine residents, it is important to recognize these differences to place emphasis on the proper areas of study. Some common or serious skin conditions not often diagnosed by internists such as psoriasis and melanoma also deserve attention in internal medicine training programs.     

An evaluation of consumer perspectives of childbirth and parenting education

As part of a study of childbirth and parenting education in the Australian Capital Territory (O'Meara, 1993a; 1993b) an evaluation of clients' views of the service was undertaken. The evaluation sought to identify indicators of effectiveness and needs. Two independent groups (current and past users, n = 207) were surveyed using an original questionnaire based on predisposing, reinforcing and enabling factors for human behaviour (Green's PRECEDE model). The data were compared and analysed using the related t-test for indicative differences in perceptions of the two groups. Indicative differences that were statistically significant were compared on variables representing users' age, parity and preferred mode of childbirth education (public or private). No evidence was found of significant differences in attitudes, beliefs and values before and after birth attributable to childbirth education. However, the health skills, confidence and emotional preparation for the birth, and the extent of participation in the learning process did not fully measure up to users' expectations. Consumers expect professionalism in the provision of services, with course content specifically tailored to their learning needs, taking into account age and previous experience of childbirth. A comprehensive curriculum is suggested covering all stages of the childbirth process from prepregnancy to parenting.     

Health consequences of pregnancy and childbirth as perceived by women and clinicians

OBJECTIVE: To develop patient-centered outcome measures for clinical research by characterizing the effects of pregnancy and childbirth on functioning. METHODS: Five focus groups of mothers (n = 33) and three focus groups of clinicians (midwives [n = 8], obstetricians [n = 4], and family practitioners [n = 7]) were convened. Discussions were audiotaped and transcribed. Major narrative themes were identified by using two independent readers and were confirmed by participants and additional clinicians. RESULTS: Themes were grouped into four outcome domains: physical, psychologic, sexual, and social. Themes identified included lack of knowledge about postpartum health, emotional lability, sexual satisfaction, depression, parenting skills, body image, fatigue, and incontinence. Lack of knowledge about typical postpartum health was the dominant theme for mothers and clinicians. Mothers felt unprepared for the health consequences of pregnancy and delivery. Clinicians lamented that paucity of data made counseling and treating patients difficult. Decreased functioning months after delivery was reported. Differences between mother and clinician concerns surfaced, particularly in emphasis. Mothers wanted more information about their health; providers emphasized newborn care. Mothers reported inspiration to improve their economic circumstances; clinicians emphasized improving maternal health. Mothers wanted control during labor, whereas clinicians believed control was not always possible. CONCLUSION: Women often felt poorly prepared for the postpartum period in part because functional health consequences are not well understood. This study suggests maternal functional health may be decreased for months after delivery, even among uncomplicated patients. This study identified new maternal outcome measures, which are being incorporated into an outcomes questionnaire.     

WISC characteristics of reading disabled children identified by three objective methods

The WISC and Spache Reading Diagnostic Scales were administered to 119 third-grade children. Groups of reading disabled children were selected by three objective methods (Below Grade Level, Bond and Tinker, and the Erickson Z-score Discrepancy). The Below Grade Level and Bond and Tinker methods tended to identify the same children whose IQs and reading achievement scores were below average. The Z-score method identified children with IQs at or above the group average. Comparison of the poor readers with control groups matched for IQ and sex gave only minimal evidence for WISC subtest patterns as characteristic of poor readers.     

Frequency of voice problems among teachers and other occupations

This study describes the frequency of reporting vocal problems among a random sample of elementary and high school teachers (n = 554) compared to individuals working in other occupations (n = 220). Teachers were more likely to define themselves as ever having a voice problem (32% versus. 1%, p < .05); having a tired, weak, or effortful voice (p < .05 each); and having a higher frequency of symptoms of physical discomfort with speaking (p < .05). They also were more likely to perceive that their voice problem negatively affected current job performance (p < .05) and limited options regarding change in work (p < .05). About 20% of teachers but only 4% of nonteachers had missed work due to their voice. These findings suggest that teachers are at high-risk for disability from voice disorders and that this health problem may have significant work-related and economic effects.     

Mathematics preparation and professional development of deaf education teachers

Tumors of the nasal fossa and paranasal region are uncommon and have non-specific initial clinical features. This complicates the diagnosis and delays treatment. We reviewed all our cases of nasal sinus tumors (84 benign, 50 malignant and 15 moderately malignant) and the relevant literature. This data was use to develop a protocol for classifying the symptoms, clinical and radiological features, coded diagnosis, and the most suitable treatment and follow-up.     

Prevalent urinary incontinence as a correlate of pregnancy, vaginal childbirth, and obstetric techniques

Rates of synonymous and nonsynonymous nucleotide substitutions and codon usage bias (ENC) were estimated for a number of nuclear and chloroplast genes in a sample of centric and pennate diatoms. The results suggest that DNA evolution has taken place, on an average, at a slower rate in the chloroplast genes than in the nuclear genes: a rate variation pattern similar to that observed in land plants. Synonymous substitution rates in the chloroplast genes show a negative association with the degree of codon usage bias, suggesting that genes with a higher degree of codon usage bias have evolved at a slower rate. While this relationship has been shown in both prokaryotes and multicellular eukaryotes, it has not been demonstrated before in diatoms.     

Measuring students' connectedness to school, teachers, and family: Validation of three scales.

Connectedness to school, teachers, and family are all significant protective factors in adolescents' lives, yet the measurement of each varies considerably. This article describes the measurement properties of three composite scales of adolescent connectedness, adapted from the Add Health study and the California Healthy Kids Survey. These composite scales are created by either summing or taking the mean of all individual items, measured on an ordinal scale. This approach fails to account for the ordinal, non-normal nature of the data. Using a covariance approach, this article describes the measurement properties of the latent constructs of connectedness to school, teachers, and family and the contribution of each of the items used to compile the relevant composite score. The outcomes of this study will provide researchers and practitioners with information about the validity, reliability, and overall usefulness of each of the measures of adolescents' perception of their connectedness to school, teachers, and family. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A review of problems in iron-ore reduction by solid-state processes

Abstract

This paper reviews the problems involved in iron-ore reduction by the solid-state processes. These processes are mostly limited to a 700°–1100°C temperature range. Because the rate of chemical reactions is relatively slow within this range compared with the blast furnace in which temperatures are much higher, the kinetics of iron-ore reduction assumes great importance.

The generally accepted reduction mechanisms are described as well as the reaction rate-controlling steps and chemical equilibria. With this background as a basis for comparison, the problems in reduction of iron ores in rotary kilns using solid fuel reductants, in shaft furnaces using gaseous reductants and in fluid-bed reactors are analyzed. This analysis shows that rotary kilns present the most problems and fluid-bed reactors the least.

Résumé

Dans cet article on examine les problèmes que comportent les procédés de réduction de minerai de fer à l'etat solide. Pour de tels procédés, la réduction se fait, en général, entre 700 et 1100°C. Les vitesses de réaction sont lentes à de telles températures, en comparaison avec le haut-fourneau où la température est beau coup plus elevee; de ce fait, la cinétique de la réduction du minerai de fer revêt une grande importance.

On décrit les méchanismes de la réduction généralement acceptés, les étapes limitant la vitesse de réaction et les équilibres chimiques, on examine les problèmes que comportent la réduction de minerais de fer en four rotatif avec agents reducteurs solides, en fours verticaux avec gaz réducteurs et en réacteurs à lits fluidisés. De cela on conclut que ce sont les fours rotatifs qui présentent le plus de problèmes et les réacteurs à lits fluidisés qui en présentent le moins.     

Conceptual, methodological, and ethical problems of placebo groups in psychotherapy research.

Psychotherapy researchers have long recognized the need to control for expectancy effects, therapist contact, and therapist attention and have generally subsumed these therapeutic factors under the placebo effect rubric. The authors suggest that the need to control for such factors must be distinguished from the necessity for a placebo group. A psychotherapy placebo group that meets the classic criteria (i.e., a theoretically inert procedure without specific activity for the condition being treated) may be unethical, impractical, or methodologically unsound in psychotherapy research of moderate or greater length. The authors suggest that the term placebo group be abandoned and that alternatives, such as "best available" therapies, component control conditions, neutral expectancy controls, and counterdemand manipulations, be used. The necessity for wait-list controls in psychotherapy research is discussed. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The discovery, in Drosophila, of viruses belonging to three new groups

Viruses belonging to three new groups have been discovered by the technique used to detect the Picornaviruses. Virus F was found in two French laboratory stocks of D. melanogaster. Virus G and virus RS came from wild flies: a sample of D. melanogaster from Guiana (virus G) and a mixture of different Drosophila species from Singapore (virus G and virus RS).     

Superfecundation identified by HLA, protein, and VNTR DNA polymorphisms

Parentage analysis has revealed a high probability that a man accused of paternity is the biological father of a male child. The child in this study, however, was the twin of a female child who could not have been fathered by the accused man. The mother of the children subsequently accused a second, unrelated man, who was excluded from paternity of the boy, but was very probably the biological father of the girl.     

Measuring and changing teachers' differential behavior as perceived by students and teachers.

Students' perceptions of their teachers' differential behavior were compared with the perceptions of the teachers themselves. Students and teachers agreed that the low achiever receives more learning support and less pressure than the high achiever. However, students reported that the high achiever receives more emotional support, whereas teachers reported giving more emotional support to the low achiever. A 2nd experiment consisted of an experimental intervention in which teachers were given feedback about the gaps between their own perceptions and those of their students in the emotional support domain. The teachers were divided into effective- and noneffective-feedback groups, according to the openness and receptiveness they were observed to express. Slight changes in differential emotional support were found 3 mo later for the teachers in the effective-feedback group. However, students and teachers framed the improvement in their pre-existing cognitive schemes. Thus, gaps between students' and teachers' perceptions were somewhat decreased, but they still presented contrasting perceptions of emotional support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Amniocentesis for antenatal diagnosis. Review of problems and outcomes in a large series

The results of amniocentesis for diagnostic genetic studies on 242 patients are presented in detail. These suggest that obtaining fluid free from contaminating red blood cells is important to successful cell culture. The data also suggest that it is technically more difficult to obtain such fluid tham might be expected, despite the use of ultrasonic localization and experienced operators. Nevertheless, 97 per cent of patients who elect to complete antenatal diagnosis will ultimately obtain the information sought, in time to intervene medically if desired. Moreover, the act of obtaining this information is shown to be without significant risk to the ultimate outcome of pregnancy.     

Knowledge, opinions, and practices related to oral cancer: results of three elderly racial groups

A study of 204 inner-city, senior center participants (ages ranged from 41-96 years) was conducted to assess their knowledge, opinions, and practices related to oral cancer. Participants were either White, African-American, or of Korean descent. The interview/questionnaire revealed this cohort to lack correct knowledge of the signs, symptoms, and risk factors of oral cancer, and to have had risk behaviors associated with oral cancer. Given that oral cancer is most frequently diagnosed in those aged 65 years and older, and that this cohort tends not to obtain routine preventive oral health care, it is imperative that these seniors be educated about the risks associated with oral cancer and their need for routine oral examinations.     

Multimethod assessment of rapists, child molesters, and three control groups on behavioral and psychological measures.

12 males in each of 5 groups (rapists, child molesters, non-sex-offender inmates, low socioeconomic status [SES] volunteers, and college students who were infrequent daters) were observed interacting with a female confederate in a naturalistic interaction and in role-play scenes. Ss also completed measures including the Multiple Affect Adjective Check List, Rathus Assertiveness Schedule, Buss-Durkee Hostility Inventory, and Fear of Negative Evaluation Scale. Overall, heterosocial skill deficits were observed in child molesters and rapists in comparison with the control groups. Rapists displayed higher physiological indices of anxiety during role-play scenes that demanded assertive responses, and child molesters displayed a fear of negative evaluations. Child molesters were also characterized by highly stereotyped views of sex role behavior. Measures of hostility or impulsivity were not useful in distinguishing child molesters and rapists from the 3 control groups. Treatment and assessment implications for sex offenders are discussed. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HPV-types, cytological and histopathological findings in three groups of women with possible HPV-related disease

OBJECTIVE: The aim of this investigation was to study three groups of women presenting with possible HPV-infection with regard to HPV-types and cervical dysplasia. METHODS: Eighty women were included. Eighteen of them were present partners to men with condylomas, 20 had clinical vulvar HPV-lesions and 42 were referred due to an abnormal PAP-smear. Samples for HPV-analysis by PCR-technique were taken from the vulva, the portio and the cervical canal. A universal HPV-primer as well as specific primers for HPV 6/11, 16, 18, 31, and 33 were utilized. PAP-smears were taken as well as biopsies from cervix/portio. RESULTS: Seventy-eight percent had HPV-DNA identified. Sixty-seven percent of those with HPV 16 and/or 18 had dysplasia verified by histopathology and 50% of those with 31 and/or 33. Twenty of 21 women with dysplasia had HPV 16, 18, 31 and/or 33 identified. One woman with dysplasia was HPV-negative. Histopathologically verified CIN were diagnosed in all groups investigated. Women referred for suspicion of CIN significantly more often had HPV detected at the cervix/portio. HPV 6/11 was mostly found in women with condylomas. Apart from this the occurrence of the different HPV types were alike in the three groups. CONCLUSION: Infection with HPV is a process and the usefulness of different diagnostic methods seems to depend on when during the course of the disease they are used. HPV-findings in women with dysplasia were all associated with oncogenic virus-types. High-risk virus was often found simultaneously with low-risk virus indicating a covariation in the acquisition of the different HPV-types.     

Frequency and risk factors for voice problems in teachers of singing and control subjects

Using a questionnaire format, 125 teachers of singing and 49 control subjects indicated whether they had a current or past voice problem, and provided information about their demographic characteristics, voice use patterns, and medication use. The results revealed similar rates of current voice problems reported by the two subject groups. However, teachers of singing were considerably more likely to report ever having had a voice problem than controls (64 vs. 33%). Risk factors were similar for the two groups. Dehydrating medications and a report of a past voice problem both increased the likelihood of perceiving a current problem, by a factor of three and five, respectively. Females were twice as likely to report a past voice problem as males, and younger subjects were slightly more likely to report a past problem as compared with older subjects. The implications of the findings are discussed from a theoretical as well as pragmatic perspective.