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Sociologic perspectives on juvenile violence.

In sum, there are four sets of social factors that help us understand why juvenile violence appears when, and where, it does, and why some communities and entire societies are persistently wracked by youth violence whereas others are largely spared its worst expressions. When it comes to the first three factors in particular--deprivation, disorganization, and brutalization--the evidence for these links is as strong as anything in social science, and that evidence is supported by a variety of sources and a variety of methods of investigation. Such investigation includes the knowledge we gain through social intervention. Some of the most effective violence prevention programs are successful precisely because they confront and deflect the social forces that otherwise often lead to violence. Consider, for example, the home-visiting programs that work with poor parents in disorganized communities to lower the risks of child abuse; and some of the more "holistic" or "multisystemic" efforts to work with violent juvenile offenders. The best of these programs work by tackling the problems of social isolation and lack of supports in the community, as well as immediate issues of economic survival for vulnerable families and children. More generally, we know that the availability of steady and rewarding work in the future, of the kind that can reliably sustain a family, is one of the most important factors allowing some youths to "desist" from violence as they mature. These conclusions give us much to be encouraged about, and much to be alarmed about. On the one hand, understanding that youth violence often is rooted in a set of adverse social conditions that are identifiable, and potentially modifiable, is a fundamentally optimistic message. It reminds us that the level of juvenile violence we suffer in America today is neither fated nor inevitable. Other societies that are in many respects much like us suffer far less of it; so could we, and we increasingly understand some of the ways in which we could make that happen. We know that some programs designed to increase opportunities and supports for high-risk youth and families do work, and we know that there are broader social and economic policies--policies that are not abstract visions, but have actually been put into place in societies much like our own--that can significantly diminish the pressures toward violence that are bred by poverty and social insecurity among the young. But knowing what to do is one thing, and actually doing it is another. In this there is much reason for concern. The 7-year economic boom that began in the early 1990s has had salutary effects on youth violence, mainly by providing improved economic opportunities for low-income youth and, accordingly, diminishing the appeal of illegal activities. Despite that extraordinary burst of sustained prosperity, however, too many of America's youth remain impoverished, sometimes desperately so: the boom has had only limited effect on our disturbingly high rates of family poverty, which continue to tower above those of comparable industrial societies. And if the boom should come to an end, and we enter again into a period of rising joblessness for youth and young adults, then much, or all, of the recent gains could be quickly lost. The positive economic trends that have helped take the edge off serious juvenile violence in the past few years, in short, are both partial and fragile. Worse, some of our recent social and economic policies, at both state and federal levels, are working in the opposite direction. Some variants of welfare reform, for example, have tossed many vulnerable families off of public assistance without offering solid economic opportunities in its place. Many more families face this future as federal time limits on public welfare increasingly come into play. Given what we know about the links between deprivation and youth violence, this is not a development we can celebrate. (ABSTRACT TRUNCATED)

Adolescent↗

[From asthmatic crisis to severe acute asthma].

Life-threatening acute attacks constitute the major complication of asthma. These attacks develop progressively or abruptly, within minutes. They are responsible for a mortality rate which in France has been estimated at 3 in 100,000 inhabitants. Most of the deaths occur before any medical assistance is given. Such deaths in serious attacks are caused by bronchial obstruction and not by possible cardiovascular complications. Since inflammation of the bronchi is now thought to be the primum movens of these near-fatal to fatal attacks, nothing but an early and prolonged anti-inflammatory treatment can prevent them. Because no precise profile of subjects at risk can be drawn, it is necessary to supervise with the utmost attention all patients who suffer from attacks of acute asthma which, unless proven otherwise, should be regarded as potentially serious: signs of severity must be systematically looked for, and strict therapeutic and monitoring measures must be taken.

Acute Disease↗

Risk targeting in cervical screening: a new look at an old problem.

In the face of continuing debate about the level of effectiveness of the United Kingdom cervical cytology screening programme in preventing cervical cancer, more precise targeting of high risk groups might offer a means of enhancing its efficiency. Broad risk targeting is already practised by screening only sexually active women aged 20 to 65 years. This paper describes a risk scoring system constructed from the available literature and designed to be used by primary care health professionals and patients. The system involves four independent risk factors: educational level, current smoking habit, years of oral contraceptive use and number of sexual partners. Since the objective is simply to identify women at relatively high risk, inclusion of a factor neither requires nor implies causality. The next steps are to study the feasibility of putting the scale to practical use and to investigate its predictive value in a prospective evaluation.

Age Factors↗

Pathology and pathophysiology of vascular cognitive impairment. A critical update.

The prevalence, morphology, and pathogenesis of vascular dementia (VaD), recently termed vascular cognitive impairment (VCI), and of mixed dementia (Alzheimer disease associated with vascular encephalopathy) are a matter of discussion and clinical diagnostic criteria for these disorders slow low sensitivity and variable specificity. In Western memory clinic-based series, VaD/VCI is suggested in 8-10% of cognitively impaired elderly subjects. Its prevalence in autopsy series ranges from 0.03% to 58% with reasonable values of 4-10%. It has been related to focal, multifocal or diffuse cortical and/or subcortical microinfarcts and lacunes often affecting strategically important brain areas (thalamus, frontobasal and/or limbic systems), hemispheric white matter lesions and, less often, large brain infarcts. They result from systemic, cardiac or local large or small vessel disease. The pathogenesis of cerebrovascular lesions is multifactorial and their pathophysiology affects neuronal systems involved in cognition, memory, and behavior. Vascular pathology often coexists with Alzheimer disease (AD) and other dementing disorders; 25-60% of dementia cases show both AD and vascular lesions. The lesion patterns in ''pure'' VCI with predominant multiple small (subcortical) lesions related to arteriosclerosis and microangiopathies and in mixed dementia (AD associated with vascular encephalopathy), more often showing large infarcts, suggest different pathogenesis of both types of lesions. Due to the high variability of cerebrovascular pathology and its causative factors no validated neuropathological criteria exist for VCI and mixed dementia. In very old subjects selective hippocampal sclerosis may be associated with multiple other vascular pathologies. Minor cerebrovascular lesions, except for severe amyloid angiopathy, appear not essential for cognitive decline in full-blown AD, while both mild AD-type pathology and small vessel disease may interact synergistically in ''unmasking'' or promoting dementia. AD pathology is significantly less severe in the presence of cerebrovascular lesions. Further studies are needed to validate diagnostic criteria for VaD/VCI and to clarify the impact of vascular lesions on cognitive impairment as a basis for more precise clinical diagnosis, early prevention and management.

Alzheimer Disease↗

[Dentin pins: risk evaluation and precautions].

When large restorations are necessary, self screw-cutting dentinal pits are very useful auxiliaries. The main risks encountered during their utilization are: --perforation through periodontium--pulpal wound--dentinal cracks--weakness of mechanical properties of restorative material--corrosion--breakdown of the drill--pulpal warning up--unesthetical front restorations. The way to prevent those difficulties are: --precise clinical and radiological examinations--insertion point--direction--number--composition--choice of pits.

Corrosion↗

Novel reagent and method for direct determination of chloride in serum with a centrifugal analyzer.

We report a novel reagent containing ferric perchlorate, perchloric acid, and polyoxyethylene (23) lauryl ether (Brij 35) with which the concentration of chloride in serum can be measured. We applied this reagent to use with a centrifugal analyzer (CentrifiChem 400) in a dynamic bichromatic procedure, resulting in broad linearity of the standard curve (0-180 mmol/L), short analysis time (1 min), and little interference from bilirubin, hemoglobin, turbidity, or bromide ions. The reagent is simple, contains no mercury, and the combination of low acid concentration and surfactant prevents serum protein precipitation. Precision is good (for x- = 93 mmol/L, CV = 1.55%), and results correlate well with those obtained by coulometry (r = 0.974).

Bilirubin↗

[Ischemic colon and rectum necrosis after resection of the abdominal aorta].

Colorectal infarctions are a rare but serious complication following aortoiliac reconstruction. Their incidence has been reported to be about 2% in retrospective and 7-35% in prospective studies. The perioperative mortality rate reaches 40-75%. About 85% of these ischemic lesions follow resection of the infrarenal aorta because of aneurysm, only 15% after aortoiliac occlusive disease. Principal cause of the infarctions is the ligation of the inferior mesenteric artery without sufficient collateral circulation. Blood supply of the large intestine and pathogenesis of ischemic colitis are discussed in detail. The pathological and clinical presentation contains three intensity degrees. For early detection colonoscopy is useful. Prevention preoperatively consists of precise analysis of aortography, intraoperatively in perfusion control of visceral arteries. The best precaution is reimplantation of the inferior mesenteric artery into the prosthetic graft.

Aged↗

Monitoring neuromuscular blockade in the adult ICU.

Although neuromuscular blocking agents are now administered in intensive care units for extended periods, no standard has been established for their use in critically ill patients. Also, despite wide variations in individual response to neuromuscular blockade, the level of paralysis is not monitored consistently. Paralytic agents are associated with numerous side effects such as prolonged weakness, which is gaining widespread attention. Side effects may be minimized or prevented by consistent and precise monitoring of the degree of blockade. Monitoring is best accomplished by the expert use of the peripheral nerve stimulator. The evoked responses must be correlated with clinical signs of muscle movement. Furthermore, staff education regarding the pharmacology of these agents and the proper operation of the peripheral nerve stimulator must be ongoing.

Electric Stimulation↗

[Percutaneous trephine for vertebral biopsy].

We performed percutaneous vertebral biopsy on 18 patients (March 1978 to March 1992) using a Craig trephine needle under fluoroscopic control, a more reliable and safer procedure than open vertebral body biopsy. Material for histopathologic examination was obtained in 17 of the 18 patients and there were no complications. Possible complications involve mostly in the cervical and dorsal spine. They can be prevented by using very precise and delicate technique under reliable fluoroscopic control in the operating room.

Adolescent↗

Molecular mechanisms of hematologic malignancies.

This article reviews both the role of signal transduction in human cancer and the recently uncovered molecular mechanisms involved in a large number of human hematologic malignancies. Chronic myelogenous leukemia, follicular lymphoma, and colorectal carcinoma are used as models to illustrate the different, as well as partly convergent, molecular pathways involved in the multistep process of human neoplasias. Examples are also provided as to how unique molecular markers can be used as fast, sensitive, and precise tools for cancer prevention, early diagnosis, and the management of residual disease.

Base Sequence↗

[Contributions of epidemiology to therapeutic decisions in psychiatry].

Since the 70's, the study of interventions methods (evaluation of their influence upon disease and of their use by care-giving structures) has been one of the main fields of research in epidemiology. Consequences of these studies upon therapeutic decisions can be the following: 1) From the diagnostic point of view, epidemiology has much contributed to the elaboration of the most recent classification systems (DSM III and IV, ICD 10) and to the determination of detection strategies in order to improve knowledge about psychiatric disorders in primary care. 2)The contribution of epidemiology to the decision to treat varies according to the kind of intervention: epidemiology has brought definitive means in evaluating prognosis of disease, the basis of tertiary care (prevention of relapse, recurrence and chronicity); epidemiology works have also identified many risk factors for various mental diseases; they sometimes allow to define secondary prevention strategies about a precise risk factor, but nevertheless have not led to elaborate predictive models in order to identify subjects candidate to specific treatments. 3) Epidemiology has also contributed to improve choice among treatments, depending on an advantage/risk ratio: as the first advantage expected from a treatment, efficacy remains difficult to evaluate for some therapeutic decisions (hospitalization, psychotherapy,...). Experimental epidemiology though led to establish references in the pharmacological treatment field for many psychiatric disorders. Nevertheless, utilisation of results brings many problems, theoretical (interpretation and generalization of results), as well as practical (applicability); evaluation of risks due to medications (side-effects and accidents, suicide risk) has been sustained by pharmacovigilance studies, the results of which led in some cases to establish regulations for prescription.

Clinical Trials as Topic↗

Osteomyelitis of the fibula due to septic embolism: a rare complication of a graft enteric erosion. Case report.

We report the case of a 70-year-old female who experienced a graft enteric erosion (GEE) three years after a right aorto-femoral bypass. She was treated by right axillo-femoral bypass, removal of the aortic prosthesis and direct aortic suture. The duodenum was stitched up and separated from the aorta by omentoplasty. Bacteriological culture of the removed graft identified Escherichia coli and Peptostreptococcus. Antibiotic therapy consisting of Amoxicillin and Gentamycin was given for seven days. A month later this patient developed a fibula osteomyelitis due to the same germs. She was then treated by surgical excision of the infected tissues and by antibiotics: Amoxicillin, Metronidazole and Gentamycin for one month. This case of embolism into bone due to GEE is a rare complication which indisputably establishes a link between the spontaneously septic cavity of the bowel and bone tissue by way of blood via the interstices of the fabric. The prosthesis may be responsible for blood seeding infection and not only a mere victim. The prosthesis acts as a porous membrane which allows two opposite flows: the passage of blood from graft to bowel and germ migration from naturally septic bowel to blood. When a GEE is encountered, a rigorous management is required to prevent septic embolism. The precise timing of each step of the surgical procedure remains difficult to codify.

Aged↗

Preventing levodopa-induced dyskinesias.

The precise cause of levodopa-induced dyskinesias is unknown. Current evidence indicates that dyskinesias develop in response to pulsatile stimulation of striatal dopamine receptors. The half-life of the dopaminergic agent employed and disease severity are thought to affect the occurrence of pulsatile stimulation. Dyskinesias are not seen or are attenuated with continuous delivery of levodopa or short-acting agonists, or with the use of long-acting agonists. In advanced disease, there are fewer striatal dopamine terminals and reduced buffering capacity; fluctuations in plasma levodopa concentration are more likely to cause fluctuations in striatal dopamine concentration and pulsatile stimulation of dopamine receptors. Pulsatile stimulation is thought to induce postsynaptic gene and protein changes that result in alterations in the patterns of neuronal communication, with the emergence of dyskinetic movements. Thus, strategies preventing pulsatile stimulation may prevent the development of dyskinesias. These could include the use of dopaminergic agents with a relatively long half-life, neuroprotective therapies that prevent the loss of dopamine neurons, and transplantation strategies or trophic factors that increase the number of dopamine terminals capable of buffering fluctuations in striatal dopamine. Alternatively, approaches that interfere with or compensate for postsynaptic molecular and neurophysiologic changes that ensue in downstream neurons might provide antidyskinetic benefits.

Dopamine Agents↗

Suppression of nitrative damage by metallothionein in diabetic heart contributes to the prevention of cardiomyopathy.

Diabetic cardiomyopathy has become a major contributor to the increased mortality of diabetic patients. Although the development and progression of diabetic cardiomyopathy are considered to be associated with diabetes-derived oxidative stress, the precise mechanisms for and effectively preventive approaches to diabetic cardiomyopathy remain to be explored. Recent studies showed that reactive oxygen or nitrogen species (ROS/RNS) not only play a critical role in the initiation of diabetic cardiomyopathy, but also play an important role in physiological signaling. Therefore, this review will first discuss the dual roles of ROS/RNS in the physiological signaling and pathogenic remodeling leading to cardiomyopathy under diabetic conditions. The significant prevention of diabetic cardiomyopathy by metallothionein (MT) as a potent and nonspecific antioxidant will be also summarized. It is clearly revealed that although dual roles of peroxynitrite-nitrated proteins have been indicated under both physiological and pathogenic conditions, suppression of nitrative damage by MT in the diabetic heart is the major mechanism responsible for its prevention of diabetic cardiomyopathy. Finally the potential for clinical enhancement of the cardiac MT expression to prevent or delay the occurrence of cardiomyopathy in diabetic patients will also be addressed.

Cardiomyopathies↗

A new role for Ran in ensuring precise duplication of chromosomal DNA.

To prevent re-replication of DNA, the licensing of replication origins is inhibited in S phase and G2. New work by Yamaguchi et al. (in this issue of Cell) shows that the small GTPase Ran can directly inhibit licensing inside nuclei once CDKs are active late in the cell cycle.

Animals↗

Therapeutic approaches for the prevention of secondary brain injury.

The precise mechanisms underlying secondary brain damage after traumatic injury to the central nervous system (CNS) are not well understood, and delayed neuronal injury may result from pathological changes in neurotransmitter release, synthesis or generation of endogenous autodestructive neurochemicals and/ or inflammatory mediators, or alterations in endogenous protective or trophic factors. Recent identification of such factors and the elucidation of the timing of the neurochemical cascade following CNS injury provides a window of opportunity for therapeutic intervention with pharmacological compounds which modify synthesis, release, receptor binding or physiological activity of neurotoxic factors. A number of recent experimental studies have reported that pharmacological modification of the post-traumatic neurochemical milieu can promote functional recovery in a variety of animal models of CNS trauma. This paper summarizes recent work suggesting that pharmacological manipulation of several key neurotransmitter and neurochemical systems can attenuate neuronal damage and improve functional outcome associated with traumatic brain injury.

Animals↗

Cardiac rhythm disorders: problems of the present, challenges for the future.

Arrhythmology has become a well-confirmed subspecialty in cardiology. Many different fields of rhythm disorders are rapidly and constantly evolving. New and more specific oriented antiarrhythmic drugs are under evaluation, especially for the treatment of atrial fibrillation. Sudden cardiac death can be prevented by implantable defibrillators but precise selection of patients at risk and the cost remain still a major health problem. We also are unable at present to treat the substrate and to prevent the occurrence of the lethal arrhythmias which are responsible for sudden cardiac death. Pacemakers are widely used for the treatment of bradycardia but other indications are emerging like the treatment of advanced heart failure through resynchronization by biventricular pacing, as well as remote pressure monitoring in patients suffering from cardiac insufficiency. Cell therapy might one day replace pacemaker devices by correcting the failing automaticity or conduction of the heart. Atrial fibrillation is the most common arrhythmia for which ablation techniques might appear as a definitive treatment possibility but technical improvements are still awaited.

Arrhythmias, Cardiac↗

Aspirin in cardiovascular disease.

The historic genesis of aspirin as a therapeutic agent is discussed. The use of aspirin as a primary and secondary chemo-preventive agent is reviewed. Those who introduced aspirin in the late 19th century would be surprised by the uses of aspirin today. It is anticipated that existing and further studies on the use of aspirin as a primary preventive agent will establish its utility and a more precise niche for it as a chemo-preventive agent. Reports indicate that it may be useful as a chemo-preventive agent in the prevention and possibly in the treatment of cancer of the colon and other malignancies. This plebeian drug, aspirin, has earned a position, some would say an egalitarian position, along with thrombolysis and primary coronary angioplasty in the emergency treatment of AMI. There are those who would add an intravenous beta blocker and an ACE inhibitor to this regimen. The laborious history of aspirin should again remind clinicians that they should continue to heed the admonition of Alexander Pope when he asserted, "Be not the first by whom the new is tried nor yet the last to lay the old aside."

Anti-Inflammatory Agents, Non-Steroidal↗