Strategies for investigating effects of residential context. A study of depressed mood and major depression.
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Biomedical subjects
Publications and source records attributed to D J Jackson.
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Uptake and serosal transfer of the vitamins thiamine, riboflavin and folic acid have been studied in vivo in normal and parasitized rats infected with Hymenolepis diminuta (Cestoda). Regional differences in intestinal uptake of all three vitamins in both uninfected and parasitized animals were not satistically significant. In the parasitized intestine mucosal uptake and serosal transfer of thiamine were significantly inhibited, with increased mucosal accumulation of the vitamin as luminal thiamine concentration increased. Apparent increased riboflavin mucosal uptake in parasitized animals, was not matched by the reduced serosal transfer, suggesting adsorption of the vitamin in the unstirred aqueous layers. Mucosal uptake of folic acid increased in the parasitized gut; serosal transfer and mucosal accumulation were not affected. These results, indicating vitamin malabsorption associated with infection by H. diminuta, are consistent with the parasite inhibiting mucosal passive transport mechanisms. This conclusion is supported by the changes in net water fluxes associated with vitamin uptake in the parasitized intestine.
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In this chapter, we have tried to identify some of the variables related to the visual prognosis in eyes with presumed histoplasmic maculopathy. We are cognizant that a constellation of other as yet unidentifiable variables also may play a role in the visual prognosis. Also, we have reported our visual results in patients who were nt photocoagulated. Many of these patients received corticosteroid therapy in some form, but we found it impossible to compare treatment ot nontreatment groups. Our results for visual prognosis is all nonphotocoagulated eyes are in general agreement with those available in the literature. For instance, Gass et al. [1] report 20 of 38 eyes (52.6 percent) with visual acuity of 20/200 or less. Also, this same study documents retention of 20/30 or better central vision in 13 of 38 eyes (34 percent), and the visual results in our study for all 54 nonphotocoagulated eyes parallel the reported findings of Schlaegel et al. [3] where 59 percent of eyes ended with a visual acuity of 20/200 or worse, 30 percent with vision of 20/50 or better, and 18 percent with vision of 20/30 or better...
Every investigation into the efficacy and role of photocoagulation in the management of PHM has been handicapped by the lack of a valid control series. In all first eyes, the results of photocoagulation are better than in second eyes. The increased salvage rate of central visual acuityof 20/50 or better in first eyes without photocoagulation is on the order of 15.8 percent to 28.6 percent-versus 25 to 38 percent in first eyes with photocoagulation (an average of 54 percent salvage rate for all first eyes). However, in second eyes, even though the number of eyes is small, it appears that nonphotocoagulated eyes do better than those that have been photocoagulated: 46 percent of nonphotocoagulated second eyes versus 33 percent of second eyes with photocoagulation retain central vision of 20/50 or better. Comparison of our results with some of the other published studies indicates some disparity in results [1-5], arising, most plausibly, from variations in the severity of the maculopathy just prior to photocoagulation. It is our contention that carefully designed prospective studies are needed, in which cases would be randomized for treatment in groups classified according to severity of the process (for example, size of SNV, proximity of SNV to fovea, and amount and location of subretinal hemorrhage). In order to obtain sufficient cases for analysis, a collaborative study may be essential in which the results and analysis of the cases are compiled by an independent party not involved in the treatment of evaluation of the patients. Despite this lack of clinical corroboration, it is my firm belief based on clinical experience that photocoagulation does have a role in the management of this vision-threatning process.
Haemoglobin levels were measured in 2950 pregnant women attending antenatal clinics in Kimpese, Bas Zaire. 72% were suffering from moderate anaemia (haemoglobin (Hb) 7-11 g/dl) and 3.7% from severe anaemia (Hb less than 7 g/dl) at their first visit, before receiving any haematinics or anti-malarial prophylaxis. Haemoglobin levels rose with both increasing parity (P less than 0.001) and age. Multiple regression analysis revealed that parity was significant but age was not. The fall in haemoglobin early in the second trimester was greatest in primigravidae and diminished with successive pregnancies until the fourth. One in 6 primigravidae approached labour with a haemoglobin level less than 7.7 g/dl. Thick blood smears were examined from 379 women who presented in the first and second trimester. 70% of primigravidae had malaria parasitaemia, compared with 13% of multigravidae (P less than 0.001). Early malaria prophylaxis in the first 2 pregnancies is an important primary health care objective if the contribution of malaria to the significant fall in haemoglobin in the second trimester is to be averted.
Human leucocyte antigen (HLA) class I and class II typing was performed on 177 children in a rural area of The Gambia who were followed for 2 years in a longitudinal study of malaria morbidity. A comparison was made between those who experienced an episode of clinical malaria in one or both years and those who showed no evidence of infection in either year. No convincing association was found between morbidity and class I phenotype. An overall association of morbidity with the distribution of class II haplotypes was seen, but association with individual DR-DQ haplotypes were not conclusive.
The BirthPlace program in San Diego, California, is an example of a successfully "mainstreamed" alternative maternity care program. It was developed to address an access to prenatal care problem in the county, and it has successfully integrated four systems of care: 1) a private practice of nurse-midwives and obstetricians, 2) the public community clinic system, 3) the tertiary university hospital, and 4) a freestanding birth center. It provides a model of care that, if replicated, could be an answer for ensuring universal access to maternity care in the United States. The BirthPlace program primarily serves a public-funded, Hispanic population, with certified nurse-midwives as the primary providers. The program's greatest challenge has been to maintain a personalized, family-centered focus, which has been the hallmark of freestanding birth centers to date, in the face of large numbers of clients and low reimbursement for care. The program has addressed the challenge of increasing access and cost-effectiveness while ensuring family-centered care through decentralized clinic management, informed consent, culturally sensitive care, and appropriate use of technology. However, in the face of an ever-changing health care system, balancing these issues will remain a constant challenge as we reshape our maternity care services.
Current literature on the safety and efficacy of freestanding birth centers suggests that these centers are safe and have reduced costs for delivery of low-risk women compared with hospitals. Despite these findings, birth centers continue to arouse controversy and remain limited in number. Potential inequality of birth center and hospital subjects as to perinatal risk is cited as the major methodologic flaw in the current research on birth centers. Defining an appropriate comparison group is arguably the most important methodologic issue encountered in these investigations. Defining women as "low risk" according to standard perinatal risk tools is not an adequate measure of comparability, as these criteria are generally not equivalent to those defining birth center eligibility. The key is to identify groups for comparison that, at baseline, would be expected to have similar outcomes. To address this concern, a tool based on the American College of Nurse-Midwives' Nurse-Midwifery Clinical Data Set was developed to identify valid comparison subjects for birth center research. This tool focuses on birth center eligibility as opposed to traditionally defined risk. This article reviews the issues of population comparability in birth center research and presents the results of a validation study using this newly developed tool.