Evaluation of disaster assistance.
Explore the source record for details and available documents.
Costs and Cost Analysis↗
Biomedical subjects
P O'Keefe
Publications and source records attributed to P O'Keefe.
Participatory analysis for redefining health delivery in a Bombay slum.
BACKGROUND: This paper explores the application of participatory methods in a Bombay slum of 33 households, Budh Mandir, to establish the local women's perception of their health status. METHOD: Six participatory meetings were conducted alongside informal interviews with key informants. The meetings were structured with health ranking, mapping and seasonal mapping exercises. RESULTS: The participatory exercises expose the differences in perceptions between professional health deliverers and the women of Budh Mandir, as well as providing data at a household scale about the incidence of disease and important differences in the interpretation of health problems. CONCLUSIONS: Differences in the perception between local women and health professionals are noted, which, it is argued, have important implications in redefining health delivery. Some methodological problems are identified and solutions are offered. It is argued that participatory methods can act as a process through which slum dwellers can demand appropriate health care for themselves and their families. In so doing, they can redefine their health needs in order that health intervention can be directed more appropriately.
Alcoholism↗
A 'disaster' continuum?
Explore the source record for details and available documents.
International Cooperation↗
Barriers and strategies for effective chemotherapy.
Chemotherapy offers the potential for cure or substantial palliation of numerous malignancies. However, its effective use requires a carefully developed strategy to overcome the barriers presented by a variety of neoplasms. Curative treatment for those human malignancies that show sensitivity to the available drugs requires combinations of drugs in "dose intense" regimens. Autologous bone marrow transplants and cytokines allow larger doses of drugs and possibly will improve the cure rates. Maximum compliance and prevention of drug toxicity are essential.
Antineoplastic Combined Chemotherapy Protocols↗
Ceftriaxone-induced cholelithiasis.
Explore the source record for details and available documents.
Adult↗
Efficacy of intraperitoneal antibiotics in the treatment of severe fecal peritonitis.
A study was performed with rabbits to examine the efficacy of treatments for fecal peritonitis and, specifically, to determine whether it is beneficial to include antibiotics in the saline used to irrigate the peritoneum. A standardized inoculum of human stool suspension was placed in the peritoneal cavity of the rabbits. Fifty-six rabbits were studied to compare the effect of treatments begun 2 hours after peritoneal soiling. The administration of no treatment resulted in 100% mortality (14 of 14). Parenteral cefotetan 25 mg/kg intramuscularly (IM) twice a day (BID) with no other treatment reduced mortality to 50% (p less than 0.05). Cefotetan 25 mg/kg IM BID plus irrigation of the peritoneum with plain saline further reduced mortality to 21% (3 of 14, p less than 0.05). Cefotetan 25 mg/kg IM BID plus irrigation of the peritoneum with saline containing cefotetan 1.0 mg/mL reduced mortality to 14% (2 of 14, p = not significant). These treatments also produced a progressive decrease in the number of intraperitoneal abscesses from 24.0 +/- 2.1 (mean +/- SEM) in the animals receiving no treatment to 9.7 +/- 1.2 abscesses in the animals receiving peritoneal irrigation with saline containing cefotetan (p less than 0.001). A second experiment then was performed specifically to examine the efficacy of intraperitoneal antibiotics. A lethal fecal inoculum was determined in rabbits receiving conventional therapy, i.e., parenteral antibiotics (cefotetan) and irrigation of the peritoneum with plain saline. With two hours delay before treatment, cefotetan 25 mg/kg IM BID and irrigation with plain saline produced 80% mortality (11 of 14). Cefotetan 25 mg/kg IM BID plus cefotetan 1.0 mg/mL in the saline washout reduced mortality to 21% (3 of 14, p = 0.003) and markedly reduced the number of intraperitoneal abscesses from 13.4 +/- 0.7 in the animals receiving irrigation with plain saline to 8.1 +/- 0.8 in the animals receiving irrigation with saline containing cefotetan (p less than 0.0001). Thus, intraperitoneal irrigation with antibiotics was highly effective. Serum antibiotic levels drawn 30 minutes after irrigation were 112.7 +/- 22.4 micrograms/mL in animals that received irrigation with plain saline, and 101.7 +/- 15.2 micrograms/mL in animals that received irrigation with saline containing cefotetan. These serum levels were not significantly different. With 6 hours delay before treatment, all therapy was less effective. Cefotetan 25 mg/kg IM BID and irrigation with plain saline resulted in 100% mortality (14 of 14). With 6 hours delay, cefotetan 25 mg/kg IM BID and irrigation with saline containing cefotetan reduced mortality to 80% (11 of 14).(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
Cutaneous lesions of histoplasmosis with transepidermal elimination in a patient with acquired immunodeficiency syndrome.
Histoplasma capsulatum is a dimorphic pathogenic fungus that produces a variety of self-limiting disease syndromes in healthy persons, but commonly disseminates in immunocompromised hosts. Although histoplasmosis has been recently described in patients with acquired immunodeficiency syndrome, it is an uncommon finding, occurring in fewer than 0.5 percent of patients with acquired immunodeficiency syndrome. We are reporting a second case of disseminated histoplasmosis presenting as keratotic papules with transepidermal elimination of Histoplasma capsulatum. Our case demonstrates the importance of including histoplasmosis in the differential diagnosis of keratotic papules occurring in patients with acquired immunodeficiency syndrome.
Acquired Immunodeficiency Syndrome↗
Multicenter, randomized trial of ciprofloxacin plus azlocillin versus ceftazidime plus amikacin for empiric treatment of febrile neutropenic patients.
In a multicenter, randomized clinical trial, the efficacy of ciprofloxacin plus azlocillin was compared with that of a standard regimen of ceftazidime plus amikacin for the initial empiric treatment of fever in neutropenic cancer patients. In addition, the efficacy of early conversion from intravenous therapy to orally administered ciprofloxacin was compared with that of continued ceftazidime plus amikacin. Seventy-one oncology patients with 79 episodes of fever and neutropenia were randomly assigned to receive initial empiric antibiotic therapy with either intravenously administered ciprofloxacin and azlocillin followed by orally administered ciprofloxacin (regimen 1, 25 episodes); ceftazidime and amikacin (regimen 2, 30 episodes); or ceftazidime and amikacin followed by oral ciprofloxacin (regimen 3, 24 episodes). Microbiologically documented infections were the cause of fever in 10 (40 percent), seven (23 percent), and nine (38 percent) episodes in regimens 1, 2, and 3, respectively, including six, five, and four episodes of bacteremia. Patient survival was 90 to 92 percent in each regimen; however, some modification of antimicrobial therapy occurred in 65, 44, and 41 percent of surviving patients in regimens 1, 2, and 3, respectively. The rate of clearance of initial bacteremia was 67 percent (four of six) in regimen 1, 100 percent (five of five) in regimen 2 and 50 percent (two of four) in regimen 3. Patients in regimens 1 and 3 were able to convert to orally administered ciprofloxacin in 32 (65 percent) of 49 episodes after a mean of six days of intravenous therapy. Superinfections occurred in 24, 10, and 12 percent of patients receiving regimens 1, 2, and 3, respectively, and occurred similarly for patients receiving orally administered ciprofloxacin, 12 percent (four of 32), and intravenous therapy, 17 percent (eight of 47). Parenteral ciprofloxacin was generally well tolerated. One (4 percent) of 25 patients receiving regimen 1 experienced oto- or nephrotoxicity, compared with eight (15 percent) of 54 patients receiving regimens 1, 2, and 3 (p = 0.15), including three patients who required premature termination of aminoglycoside therapy. Our data suggest that the combination of ciprofloxacin and azlocillin is an effective alternative to ceftazidime and amikacin for the initial empiric therapy of febrile neutropenic patients, is generally well tolerated, and avoids the oto- and nephrotoxicity associated with aminoglycoside use. In addition, a majority of patients could change to orally administered ciprofloxacin alone after six days of parenteral therapy.
Adult↗
The value of continuous 72-hour peritoneal lavage for peritonitis.
Studies were performed in 120 rabbits to determine whether 72-hour peritoneal lavage is beneficial or harmful in the treatment of peritonitis. Results showed that against a high concentration fecal inoculum (90 percent mortality), peritoneal lavage containing gentamicin and clindamycin reduced mortality to 10 to 20 percent (p less than 0.05). Parenteral antibiotics alone and lavage not containing antibiotics did not decrease mortality. By contrast, against a low fecal inoculum (30 percent mortality), peritoneal lavage containing gentamicin and clindamycin did not alter mortality. However, lavage not containing antibiotics increased mortality to 70 to 80 percent (p less than 0.05). These data demonstrate that continuous peritoneal lavage may be helpful in the treatment of peritonitis provided the lavage solution contains antibiotics and may be harmful if it does not contain antibiotics.
Animals↗
Thermally induced formation of polychlorinated dibenzofurans from Aroclor 1254-contaminated mineral oil.
Numerous laboratory simulations and real-world events have demonstrated the thermal conversion of neat or high concentration of PCBs into the much more toxic PCDFs. Since millions of mineral oil transformers currently in service contain PCB concentrations in the 50 to 5000 ppm range, the thermal behavior of dilute PCB solutions is of practical and regulatory significance. In this work, neat Aroclor 1254 and 5000 ppm Aroclor 1254 in mineral oil were subjected to pyrolysis and combustion under a range of experimental conditions to define parameters resulting in maximal PCDF yields. The dependence of PCDF yield on Aroclor 1254 concentrations was then investigated in the 5000 to 50 ppm range. Combustion experiments demonstrated that PCDF yields expressed as micrograms PCDF/gram PCB were independent of concentration range, confirming that the process is kinetically first order in PCB. Much lower yields of PCDF were observed in the open tube pyrolysis experiments, as compared to combustion experiments and to earlier and concurrent sealed tube experiments. Slightly improved yields were observed in the pyrolysis experiments at lower concentrations, suggesting the existence of a PCB or PCDF destruction process of higher than first order kinetics. In all cases, yields expressed as micrograms PCDF/gram mixture were sharply and monotonically lower as concentrations decreased between neat or 5000 ppm Aroclor 1254 and 50 ppm Aroclor 1254.
Aroclors↗
Clinical dietitians: on the critical list. Tough ADA requirements & low pay threaten to turn dietetics into a 'forgotten' profession.
Explore the source record for details and available documents.
Dietetics↗
Medical decisions and prognostications of pediatricians for infants with meningomyelocele.
To determine how pediatricians' prognostications and decisions about the treatment of infants with meningomyelocele are affected by varying degrees of hydrocephalus, we randomly selected a sample of pediatricians to receive written surveys. This questionnaire assessed the relationship between the decisions and the prognostications, and compared their accuracy with that of outcome studies. Each pediatrician completed a questionnaire for two of three possible cases, which were identically described as infants with meningomyelocele and complete paraplegia varying only in the degree of hydrocephalus at birth from none to moderate to severe. Recommendations for treatment and prognostications (the Prognostics Belief Scale of Impressions of adult functional capabilities and likely residential and vocational placements) were compared. Significantly fewer pediatricians would present information to parents in an encouraging light, and significantly fewer would treat their own child, if the case involved severe hydrocephalus in comparison with no hydrocephalus. Pediatricians' prognostications were the least optimistic for the infant with severe hydrocephalus and most optimistic for the infant without hydrocephalus, and they were considerably less optimistic than seems justified on the basis of follow-up studies. Last, physicians' less-than-optimistic prognoses were significantly related to their decisions concerning surgery for the infants with moderate and severe hydrocephalus. The major import of the findings is that pediatricians' prognoses reflect, in part, a misconception of the impact of hydrocephalus on children born with meningomyelocele and that these prognoses then have and impact on the pediatricians' decisions concerning treatment.
Decision Making↗
Incidence and microbiological etiology of middle ear effusion complicating endotracheal intubation and mechanical ventilation.
Explore the source record for details and available documents.
Adult↗
Relationship between children's attitudes toward and their social acceptance of mentally retarded peers.
The relationship between the attitudes children express toward mentally retarded peers in laboratory settings and their social acceptance of such peers in their mainstream classrooms was examined. Forty-six fourth through sixth graders expressed their attitudes toward an unknown mentally retarded student presented in a videotape. They also indicated their social acceptance, rejection, or neglect of a mentally retarded peer in their classroom. A step-wise multiple regression analysis showed that children's attitudes toward the target child in the laboratory setting were related to their sociometric choices of the retarded classmate. Results supported previous indirect evidence of a relationship between children's attitudes toward retarded peers presented in a laboratory setting and their social acceptance of retarded peers mainstreamed in their classrooms.
Adaptation, Psychological↗
Pediatricians' perceptions of mentally retarded individuals.
Three hundred randomly selected members of the American Academy of Pediatrics were surveyed to determine their perceptions of mildly, moderately, and severely mentally retarded individuals. For each of the three categories of mental retardation, pediatricians completed the Prognostic Beliefs Scale which consisted of 27 functional capabilities and choices of residential and vocational placement. Of the 169 (56%) questionnaires returned, 142 (47%) were available for analysis. The pediatricians' perceptions were different for mildly, moderately, and severely retarded individuals. Most pediatricians believed mildly retarded individuals could do all but tasks requiring judgment, could function in unskilled competitive employment, and were likely to live in their own apartments. They believed that those with moderate retardation were limited in their capacity to simple and supervised tasks, could function in sheltered workshops, and were likely to live in group-home settings. They believed that severely retarded individuals were restricted to simple feeding tasks and following one-stage commands, were not capable of any productive employment, and would most likely live in institutions. Pediatric expectations and prognostications for placements were significantly lower than those of other professionals caring for mentally retarded individuals.
Attitude of Health Personnel↗
Calculation of 2,3,7,8-TCDD equivalent concentrations of complex environmental contaminant mixtures.
Sufficient toxicological data are now available to permit use of conventional risk assessment techniques to estimate the hazards associated with human exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD). However, many real-world exposures involve complex mixtures of dibenzodioxins, dibenzofurans, and related compounds. Historical approaches to risk assessment on such mixtures have ranged from ignoring all compounds except 2,3,7,8-TCDD itself to assuming that all compounds have potencies equal to 2,3,7,8-TCDD. An alternative approach which uses existing literature data and analytical results to calculate the "2,3,7,8-TCDD equivalent" concentration of a mixture in order to "predict" its biological potency relative to 2,3,7,8-TCDD itself is advanced here. Previously reported in vivo acute and subchronic studies and some recently obtained analytical chemistry data are integrated here to clarify the utility of this important approach and to assess the uncertainties associated with its use. This predictive approach, and various conceptually similar ones, have now found wide applicability to the risk assessment process associated with exposure to complex mixtures of dioxins, dibenzofurans, and related compounds.
Alanine Transaminase↗
Bacteriology of hospital-acquired pneumonia.
Hospital-acquired pneumonia was studied prospectively for 3 1/2 years in a 549-bed facility with acute medical-surgical care wards, convalescent wards, and a chronic care unit. Bacteriological studies were limited to transtracheal aspirates, pleural fluid, and blood cultures. The predominant isolates in 159 patients were gram-negative bacilli (47%), anaerobic bacteria (35%), Staphylococcus aureus (31%), and Streptococcus pneumoniae (26%). Nearly half of all specimens yielded a polymicrobial flora with more than one potential pathogen. Distribution of pathogens was similar with analysis of all patients, including patients with a monomicrobial infection and patients with bacteremic pneumonia. The prevalence of cases and distribution of bacteria were similar for patients located on acute medical-surgical wards and those in the nursing home care unit. Nosocomial pneumonia was judged directly responsible for lethal outcome in 19% of patients and a contributing factor to death in another 13%.
Bacteriological Techniques↗
The uptake of preventive and curative child health services in Maputo, Mozambique.
This study seeks to analyse the uptake of preventive and curative child health services in three health centres in Maputo, Mozambique. Within the context of overall social and economic change, Mozambique has given priority to Primary Health Care as the driving force of its newly developed National Health Service, with a principal focus on maternal and child health. Three health centres were selected from areas of contrasting environmental quality. Data were collected from over 6000 women attending the curative and preventive child health services at these centres. It was found that the women using curative services had significantly higher child mortality rates, had lived less time in Maputo City and had children of lower weight status than their counterparts attending for preventive care. Additionally, levels of child mortality were found to increase as environmental quality decreased. It is argued that the lower users of preventive care are, as in the U.K., precisely those who appear to have an increased risk of mortality and morbidity. It is concluded that integration between the curative and preventive health services must be increased in order to overcome the user inertia which militates against the poorer population using the facilities for prevention to the best advantage. This would fit in both with national strategies (1) and WHO recommendations (2-4) in the field of primary health care.
Age Factors↗