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PubMed2006

Statistics and public health at CDC.

Since CDC's inception, an important function of the agency has been the compilation, analysis, and interpretation of statistical information to guide actions and policies to improve health. Sources of data include vital statistics records, medical records, personal interviews, telephone and mail surveys, physical examinations, and laboratory testing. Public health surveillance data have been used to characterize the magnitude and distribution of illness and injury; to track health trends; and to develop standard curves, such as growth charts. Beyond the development of appropriate program study designs and analytic methodologies, statisticians have played roles in the development of public health data-collection systems and software to analyze collected data. CDC/ATSDR employs approximately 330 mathematical and health statisticians. They work in each of the four coordinating centers, two coordinating offices, and the National Institute for Occupational Safety and Health.

Centers for Disease Control and Prevention, U.S.↗
PubMed1991

Weight-training injuries in children and adolescents.

Thousands of children and adolescents participate in weight lifting for recreation or as a means of training for sports. Weight lifting can cause serious musculoskeletal injuries, such as ruptured intervertebral discs, spondylolysis and spondylolisthesis, fractures and meniscal injuries of the knee. Deaths related to weight lifting have been reported. Although the incidence of weight-lifting injuries is not well documented in children and adolescents, several reports indicate that few injuries occur in carefully supervised programs. The most common cause of injury appears to be loss of form when heavy weights are lifted. Proper technique, good supervision and training programs appropriate to the athlete's level of physical and emotional maturity are important.

Adolescent↗
PubMed1991

A clinical approach to computerized perimetry.

Computerized perimeters have increased the precision with which visual fields may be tested. The purpose of this paper is to present considerations for properly performing automated perimetry. Selecting the correct perimeter to complement specific practices is discussed, and various test strategies available on automated perimeters are reviewed. Selection of the appropriate program to provide the clinician with the information needed is essential. A step-by-step discussion as to proper performance of automated perimetry includes factors that should be considered so that consistency between visual field examinations can be maintained. Confounding variables, such as the learning effect, pupil size, and various ocular pathologies, are discussed with respect to their effects on automated perimetric results.

Diagnosis, Computer-Assisted↗
PubMed1991

[Doppler echocardiography of the effect of atrioventricular delay on transmitral flow in dual chamber pacing. Role of associated cardiopathy].

Doppler echocardiography was used to analyse transmitral blood flow in 23 patients undergoing DDD pacing under basal conditions at a pacing rate of 70/min. Changes in the atrioventricular delay led to changes in Doppler parameters corresponding to the different phases of ventricular filing. When the atrioventricular interval was increased, the maximum velocity, the velocity time integral and the duration of the E wave decreased and the maximum velocity, the velocity time integral and duration of the A wave increased. The atrial contribution to left ventricular filing increased by 15 to 46% (p less than 0.001). The changes of the Doppler parameters with respect to the duration of the atrioventricular interval varied according to the patient group studied. Patients without ventricular dilatation with or without hypertrophy had greater maximum velocities and velocity time integrals of the A wave than patients with left ventricular dilatation. However, for the same changes in atrioventricular delay, the A wave and atrial contribution to left ventricular filing were more variable in patients without left ventricular dilatation than those with left ventricular dilatation confirming the greater sensitivity of patients without left ventricular dilatation to the setting of the atrioventricular interval. These results confirm the great variability of transmitral flow with changes in atrioventricular delay. They illustrate the need for appropriate programming of the atrioventricular delay especially in patients in whom the mitral flow is most sensitive to this adjustment.

Aged↗
PubMed1990

Continuous blood glucose monitoring with feedback-controlled glucose infusion during surgical management of insulinoma: report of a case.

Perioperative management of insulinoma may be facilitated by the use of a glucose-controlled insulin infusion system (GCIIS; Biostator System, Miles Laboratories Inc., Elkhart, Ind.). We monitored the blood glucose levels and glucose infusion rates before, during and after surgery in a 35-year-old woman with insulinoma. After an overnight fast, glucose was infused according to a preset program and maintained the blood glucose level at around 50 mg/dl. Depression of the blood glucose level and simultaneous elevation of the glucose infusion rate were noted when the tumor was massaged. A sharp decrease in the glucose infusion rate occurred almost immediately after removal of the tumor. It took about 4 minutes for the blood glucose to go up to a level of 90 mg/dl. These results demonstrate the usefulness of GCIIS not only in maintaining stationary blood glucose, but also in localizing the tumor and in providing evidence of complete removal of the tumor. When the infusion system is programmed appropriately, the glucose infusion rate, as compared to the blood glucose level, reacts more quickly and sensitively to sudden changes in insulin levels.

Adult↗
PubMed1990

Sexual identity and practices relating to the spread of sexually transmitted diseases.

All sexually transmitted diseases are behaviorally correlated. A thorough understanding of the behaviors involved in the spread of sexually transmitted disease will increase the physician's ability to suspect, properly identify, and treat the disease. An appreciation of the common sexual behavior in contemporary American society will allow the physician to more effectively address patients' concerns about their sexuality and sexual behavior and identify areas for which further professional counseling is appropriate. Physicians are the most trusted source of health information, often counsel their patients on intimate subjects, and therefore are in a unique position to promote individual behavioral and perceptual changes for limiting the spread of sexually transmitted disease. Physicians must, therefore, be aggressive in taking sexual histories, especially for young, sexually active patients, whether heterosexual, homosexual, or bisexual. Clinicians must deliberately cultivate a comfortable, sympathetic attitude and provide an environment in which a complete and honest sexual practices history will freely flow. Once the patients at risk for STDs are identified, the physician should attempt to counsel them to reduce their risk through safer sexual practices. If little office time is available for these sensitive educational issues, then the physician should identify individuals within the office or appropriate programs in the community for referral. Representative data on the sexual behavior of all Americans will be relevant not only to the AIDS crisis but also to other national sex-related problems such as the growing incidence of chlamydia, other sexually transmitted diseases, and the costly multigenerational impact of epidemic teenage pregnancy. Comprehensive, well-designed studies of contemporary sexual behavior are needed now.

Adolescent↗
PubMed1986

[Evaluation of the posology of antibiotics].

The determination of the dose regimen of a new antibiotic is difficult because a dose/effect relationship cannot be established in patients with an infectious disease. The optimal dose is usually extrapolated from combined data provided by in vitro and in vivo microbiologic toxicologic and kinetic studies. Additional data ought to be produced in the future such as: kinetics of cidal effect in vitro, of the post antibiotic effect, of drug concentrations at the sit of infections itself, of the cidal serum activity in volunteers and patients; how these parameters are modified when modulating the mode of administration of the drug ought to be studied as well. The optimal dose, once it is roughly evaluated from classical studies, has to be adjusted: either by decreasing the dose, through an appropriate program of clinical trials with non-threatening life infections; or by increasing the dose in severe infections, through an in-depth analysis of new data available because of the improvement of: the design of clinical trials, the sensitivity of analytical techniques, the standardized serum bactericidal tests, the sophisticated monoparametric animal models simulating human infections, our knowledge of drugs mechanisms of toxicity. Establishing a rational dose regimen obviously requires a long-term multidisciplinary approach of the problem.

Animals↗
PubMed1986

Use of computers to test orthopedic knowledge.

Valid, reliable evaluation of orthopedic knowledge is an essential part of our efforts to maintain a high quality of orthopedic practice and education. Current methods of evaluation have made important contributions to the field of orthopedics and will continue to do so, but they have limitations. Computers currently help score and interpret test results as well as evaluate test items. With the development of item banks, computers can aid in test and item construction. Development of a central computer item bank with appropriate programming for specialized test construction would allow computerized test administration on home computers. The most exciting potential contribution of computers to evaluation of orthopedic knowledge will be in the development of computer simulations. Computer simulations can closely replicate the processes of making a diagnosis, directing treatment, or planning and guiding the performance of a procedure and thereby overcome some limitations of current tests. Developing methods of measuring student performance on simulations and establishing the validity and reliability of simulations as evaluation instruments will require considerable effort, but they offer the promise of providing an important method of assessing orthopedic knowledge.

Computer Simulation↗
PubMedDate not supplied

Client relations in South Asia: programmatic and societal determinants.

Client relations constitute a neglected area of research in family planning. Findings from studies in northern India and Bangladesh reveal considerable variation in both the quantity and quality of contacts in programs that function under roughly comparable socioeconomic conditions. Client relations are determined by a complex set of forces in which both programmatic factors and conditions pertaining to the societal environment play a key role. Worker-client exchanges have a net, incremental effect on contraceptive use.

Bangladesh↗
PubMedDate not supplied

Barriers to modern contraceptive use in rural Peru.

This paper examines Quechua-speaking Indians' choice of contraceptive methods and discusses barriers to the use of modern contraceptives. A study conducted in a Peruvian highland community shows that contraceptive choice is strongly related to a couple's life experiences, their contact with urban centers, their economic status, and their emphasis on cultural values. Among contraceptive users, husbands are concerned with family size and encourage their wives to seek information about the use of modern contraceptives. A discrepancy in attitudes exists between spouses: the men's positive attitude toward modern contraception contrasts with the women's traditional desire for a large family. In this study population, modern contraception is a novelty that has reached only a few families. The majority of the couples practice natural and traditional family planning methods, which are not reliable. Villagers do not use modern contraceptives as a result of cultural barriers created by family planning services that do not take into account the lifestyle of these people, insufficient knowledge of human physiology, comments from dissatisfied users, and women's reliance on their reproductive role for self-esteem.

Abortion, Induced↗
PubMed1986

Health needs and concerns of male adolescents.

Lifestyle factors established within the family help determine health-care functioning. Adolescents first may be challenged to meet their own health needs as freshmen in college. A 153-item questionnaire was utilized to examine concerns in the areas of alcohol and other drug use, auto safety, weight and dieting, smoking, sexuality, coping and stress, and selection and utilization of health-care services. One hundred fifty-nine male college students responded. Major problems with alcohol use, auto safety, weight control, stress and sexuality were identified. Positive lifestyle factors that were strongly supported included regular exercise, nonsmoking, regular medical and dental checkups, and the development of some support systems to cope with stress. Health-care services designated by respondents to meet their own needs were significantly different from those services they pointed out as needed for their peers.

Adolescent↗
PubMed1986

MicroTICAS. The design of an inexpensive video-based microphotometer/computer system for DNA ploidy studies.

A description is presented of the microTICAS video-based microphotometer/computer system, which has been designed and implemented to provide an inexpensive means for the rapid assessment of DNA ploidy patterns. The design goal was to provide a low-cost, easily serviced unit capable of providing useful clinical results and that would be easy and convenient to use. The resulting system achieves those ends as well as providing a flexible research tool that can be extended with appropriate programming to perform a wide range of tasks. The major parts of the microTICAS system are the microscope/optical system, the video camera with its control unit, the video data digitizer, the frame buffer and display monitor and the small host computer. Commercially available components were chosen for these system components and have been assembled into a system with only a minimum of modifications. The resulting system can be configured to be compatible with both North American and European standards.

Computers↗
PubMedDate not supplied

Barriers to effective family planning in Nepal.

To investigate why family planning (FP) services in the Kathmandu Valley of Nepal are underused, a study was initiated under the auspices of the Nepal Family Planning/Maternal--Child Health Project. The study was intended to provide a user perspective, by examining interactions between FP clinic staff and their clientele. "Simulated" clients were sent to 16 FP clinics in Kathmandu to request information and advice. The study revealed that in the impersonal setting of a family planning clinic, clients and staff fall into traditional, hierarchical modes of interaction. In the process, the client's "modern" goal of limiting her family size is subverted by the service system that was created to support this goal. Particularly when status differences are greatest, that is, with lower-class and low caste clients, transmission of information is inhibited.

Adult↗
PubMed1979

Treatment of subacute sepsis of the hip by antibiotics and joint replacement. Criteria for diagnosis with evaluation of twenty-six cases.

Total hip replacement fixed with acrylic cement can be successful despite past or present hip infection. Recovery of the infecting organism must be vigorously pursued, either by repeated aspirations or open biopsies. Staging the reconstruction is determined by the pathogenicity of the infecting organism, gram stain, frozen section, and above all the surgeon's observations of the condition of the wound. If in doubt, treatment of infection must take precedence over the reconstruction. Adequate antibiotic coverage should begin as soon as the diagnosis is certain and the organism identified. Antibiotics should be continued postoperatively for one month intravenously, followed by 4--8 months oral therapy, though the length of oral antibiotics could be debated. A number of authors have based their diagnosis of hip infection on clinical, roentgenographic, laboratory and bacteriologic studies. However, they have not given specific guidelines for the determination of deep hip infection. The application of the criteria outlined in this paper can distinguish superficial from deep hip infection as illustrated in 40 cases with no evidence of recurrence of infection. For the present only relative guidelines may be drawn for the treatment of subacute or recently arrested sepsis of the hip. Considering some 80,000 total hip replacements done in the U.S. in the past year, a significant number of patients will require treatment of this type and appropriate programs should be established for the welfare of the patients.

Aged↗