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PubMed2000

Clinical correlates of obsessive compulsive disorder in children and adolescents referred to specialized and non-specialized clinical settings.

The objective of this study was to assess the extent of referral bias by comparing children and adolescents with Obsessive Compulsive Disorder (OCD) ascertained through a specialized pediatric OCD and a general child psychiatry clinic. Subjects were juveniles meeting DSM-III-R and DSM IV criteria for OCD referred to a general pediatric psychopharmacology clinic and to a specialized OCD clinic within the same academic medical center. Subjects were evaluated clinically and with structured diagnostic interviews using the Kiddie SADS-E. OCD was identified in 8.6% of the general psychiatry clinic subjects. The only differences between ascertainment sources in clinical or sociodemographic characteristics of OCD subjects were higher rates of social phobia and ADHD in the non-specialized clinic, while specialty clinic subjects had a greater lifetime severity of OCD and were more likely to have received treatment of their OCD. Because we found limited evidence for referral biases, our results suggest that findings from studies using either of these sources may generalize to the other. It also suggests that pooling subjects from the two sources is justified. Nevertheless, because some group differences did emerge, researchers should acknowledge referral bias as a potential limitation of their work.

Adolescent↗
PubMed2006

Hypertension in black Americans as a special population: why so special?

Studies have shown that appropriate treatment of hypertension will reduce cardiovascular, renal, and cerebrovascular morbidity and mortality for all patients. Because hypertension has a multifaceted nature the disorder presents with unique features in prevalence, morbidity, and mortality among ethnic groups. Blacks, Hispanics, and Native Americans have been identified as special populations at risk for unique experiences with hypertension. Among these special populations, black Americans present unique issues in etiology, pathophysiology, severity, and response to treatment. This article reviews the varied aspects of hypertension detection, treatment, and control as they relate to the special population of black Americans.

Black or African American↗
PubMed2000

Dynein and plus-end microtubule-dependent motors are associated with specialized Sertoli cell junction plaques (ectoplasmic specializations).

The mechanism responsible for spermatid translocation in the mammalian seminiferous epithelium was proposed to be the microtubule-based transport of specialized junction plaques (ectoplasmic specializations) that occur in Sertoli cell regions attached to spermatid heads. These plaques each consist of a cistern of endoplasmic reticulum, a layer of actin filaments and the adjacent plasma membrane. It is predicted that motor proteins function to move the junction plaques, and hence the attached spermatids, first towards the base and then back to the apex of the epithelium, along microtubules. If this hypothesis is true, motor proteins should be associated with the cytoplasmic face of the endoplasmic reticulum component of ectoplasmic specializations. In addition, isolated junction plaques should support microtubule movement both in the plus and minus directions to account for the bidirectional translocation of spermatids in vivo. To determine if cytoplasmic dynein is localized to the endoplasmic reticulum of the plaques, perfusion-fixed rat testes were immunologically probed, at the ultrastructural level, for the intermediate chain of cytoplasmic dynein (IC74). In addition, testicular fractions enriched for spermatid/junction complexes were incubated with and without gelsolin, centrifuged and the supernatants compared, by western blot analysis, for Glucose Regulated Protein 94 (a marker for endoplasmic reticulum) and IC74. At the ultrastructural level, the probe for IC74 clearly labelled material associated with the cytoplasmic face of the endoplasmic reticulum component of the junction plaques. In the gelsolin experiments, both probes reacted more strongly with appropriate bands from the gelsolin-treated supernatants than with corresponding bands from controls. To determine if the junction plaques support microtubule transport in both directions, polarity-labelled microtubules were bound to isolated spermatid/junction complexes and then assessed for motility in the presence of ATP and testicular cytosol (2 mg/ml). Of 25 recorded motility events, 17 were in a direction consistent with a plus-end directed motor being present, and 8 were in the minus-end direction. The results are consistent with the conclusion that the junction plaques have the potential for moving along microtubules in both the plus and minus directions and that both a kinesin-type and a dynein-type motor may be associated with the junction plaques. The data also indicate that cytoplasmic dynein is localized to the cytoplasmic face of the endoplasmic reticulum component of the plaques.

Animals↗
PubMedDate not supplied

Delayed or forgone care among children with special health care needs: an analysis of the 2001 National Survey of Children with Special Health Care Needs.

OBJECTIVE: To examine the associations of sociodemographic characteristics with both the prevalence and the causes of delayed or forgone care in a nationally representative sample of children with special health care needs. METHODS: Data were abstracted from the 2001 National Survey of Children with Special Health Care Needs. The families of children with special health care needs (CSHCN) who reported delayed or forgone care were asked about the reasons. The 12 reasons in the questionnaire were grouped into 5 categories. Bivariate and multivariate logistic regression analyses were conducted in SUDAAN to examine the relationship between sociodemographic characteristics of CSHCN and the incidence of delayed or forgone care by its reasons. RESULTS: Nearly 10% of CSHCN had experienced delayed or forgone health care in the past 12 months in 2001. Logistic regression showed that delayed or forgone care was more likely to be reported by the families of CSHCN who were adolescents, who had more severe limitations, lived in the South or West, lacked medical insurance, and who lived in families under or near the federal poverty line. Hispanics were more likely to report "lack of medical specialty" and "had language, communication, or cultural problems with provider." Both Hispanics and non-Hispanic others were twice as likely to report "provider not accessible" as reasons for the delayed or forgone care compared with non-Hispanic whites or blacks. conclusion: CSHCN with certain socioeconomic status and sociodemographic characteristics, as well as those with severe limitations in activity, were more likely to be affected by circumstances that result in delayed or forgone care.

Adolescent↗
PubMed1997

Special Olympics, special smiles: assessing the feasibility of epidemiologic data collection.

No comprehensive national study has ever been completed on the oral health status of people with disabilities, their patterns of use of oral health services and access-to-care barriers. The authors describe the Special Olympics, Special Smiles program, conducted as part of the New Jersey Summer Special Olympics Games, and assess a pilot-tested model for collecting epidemiologic data. The results of this initial data collection are also compared with the goals of the U.S. Public Health Service, as outlined in the Healthy People 2000 publication.

Adult↗
PubMed2005

Special oral hygiene and preventive care for special needs.

Many dental patients have special preventive needs related to dental caries and periodontal disease, and most patients with intellectual or physical disabilities have specialized needs. This article suggests that these needs often go overlooked. To best care for patients with these needs, the dental practitioner should identify special oral hygiene needs among his or her patients, provide them with oral hygiene instruction and implement the specific oral hygiene preventive and treatment procedures described here.

Cariostatic Agents↗
PubMed2004

Special sunrise & sunset solar energy stored papers and their clinical applications for intractable pain, circulatory disturbances & cancer: comparison of beneficial effects between Special Solar Energy Stored Paper and Qigong Energy Stored Paper.

Various phases of solar energy were evaluated for possible medical application, using the Bi-Digital O-Ring Test. A 2-4 minute interval of highly beneficial phase during sunrise and sunset which is comparable or is stronger than (+) Qigong Energy was detected. This energy was stored on 3 x 5 inch index cards. The sun energy stored on the exposed surface had a Bi-Digital O-Ring Test extremely strong positive (+) response, and the opposite side of the index card which was not exposed to the sun showed an equally strong negative (-) response. When the Bi-Digital O-Ring Test strong positive side (+) was applied to the patient's skin above various intractable painful areas with circulatory disturbances, including gangrenous pain, muscle pain, joint pain, & migraine headache, most of the pain disappeared or was significantly reduced within between 10 seconds and 5 minutes, with accelerated wound healing compared with Qigong energy stored paper of the same exposure, which caused pain to disappear within between 1.5 minutes and 15 minutes. When this Special Solar Energy Stored Paper was applied either directly to the skin above cancer positive areas or the midline of the upper chest above the thymus gland representation area, or the occipital area above the medulla oblongata, various cancer related parameters returned to close to normal values, with immediate clinical improvement. The beneficial effects of 10-60 seconds of application of the Special Solar Energy Stored Paper lasted for between 7 and 40 days, depending on the individual and their environmental electromagnetic field, how the special solar energy was stored, and how it was applied to the patient.

Adult↗
PubMed2000

Helping special olympics athletes sport good smiles. An effort to reach out to people with special needs.

For the millions of people in the world with special needs, dental care is usually not a priority, often taking a back seat to more pressing and complicated medical issues. This article offers a brief overview of the integration of a dental program into the Special Olympics organization. This overview is followed by a discussion on dental education with regard to people with special needs, and then reviews measures for the prevention of injuries.

Athletic Injuries↗
PubMed1986

[After care of surgically treated ruptures of the outer ligaments of the anterior ankle joint with special reference to the special Dr. Spring shoe].

P.o. treatment of ankle joint ligament ruptures via the special shoe "adimed-STABIL" can avoid the disadvantages of complete immobilisation with a cast. An essential condition for this type of management is the reliable prevention of extreme movements by means of this shoe, such as supination, adduction as well as maximal extension and flexion. In 10 patients with ankle joint ligament ruptures we could demonstrate that the special shoe could not fulfil these requirements, as demonstrated by stress x-rays with the correctly laced shoe under anaesthesia. Due to these results immobilisation of the ankle joint by cast after reconstruction of the ligaments appears to be the method of choice. Our observations in cases of ankle joint lesions could not confirm the fear that prolonged cast immobilisation would lead to trophic changes and would require functional physiotherapy. Because of the disadvantages of the special shoe in respect of insufficient stability, high cost, lack of ventilation and the problems involved in applying or taking off the shoe, or in remaining in "shoeless condition", we can recommend using this shoe in aftercare treatment in exceptional cases only.

Adolescent↗
PubMedDate not supplied

Diagnostic ultrastructural pathology--sub-speciality or special stain?

The high resolving power of the electron microscopy gives ultrastructural pathology many of the features of a 'sensitive, multipurpose stain'. But the high resolution gives rise to problems of evaluation since most pathological features of disease are specific in a quantitative rather than in a qualitative way. Thus, pathological changes may be of diagnostic importance when they are severe enough to be seen by light microscopy, but less so when only revealed by electron microscopy. Problems of evaluation and interpretation should not lead to paralysing nihilism but should make us realize that electron microscopy does not represent the ignorant pathologist's key to a diagnostic heaven, no more than do special stains, histochemistry and immunocytochemistry. At present it may be necessary to organize ultrastructural pathology as a kind of sub-speciality of pathology. In the long run, we feel that sub-specialities should be related to the object studied rather than to the instrument used. Thus, the neuropathologist should do ultrastructural neuropathology, the cytologist ultrastructural cytopathology, etc. in the same way as most kidney pathologists already do their own ultrastructural work.

Diagnosis, Differential↗
PubMed1986

Attitudes to the medical specialities: comparing pre-clinical students' perceptions of nine specialities.

This study set out to compare pre-clinical (2nd year) and clinical (5th year) medical students' attitudes to nine specialities. Previous research using the questionnaire employed in this study revealed a large number of significant differences, particularly with regard to pre-clinical students' beliefs about and attitudes towards psychiatry, general practice and surgery. Both multivariate (factor analysis) and univariate (analysis of variance) analyses showed significance main effects for both group (2nd vs 5th years) and speciality but perhaps more importantly significant interactions. Both predispositional and socialization factors are used to account for the difference in students' attitudes and beliefs over time. The advantage of longitudinal over cross-sectional designs is also discussed.

Analysis of Variance↗
PubMed1984

What's so special about special care?

Special care units are the most advanced, intensive, technological, and costly of hospital services. They also have proliferated rapidly. Yet little is understood about the definition, prevalence, genesis, costs, or benefits of SCUs. This paper defines and examines the many forces that have promoted the growth of special care, including hospital cost containment policies, fee-for-service reimbursement, medical ethics, standards of care, and manpower, and the much less numerous forces that have inhibited its spread. It is concluded that a sound appreciation of the dynamics of SCUs will be crucial to guiding future policy decisions as the nation's population ages and as hospitals continue to improve their capability to care for critically ill patients.

Attitude of Health Personnel↗
PubMed1995

[Is gender of significance for specialization of physicians? An analysis of specialization degree among female and male physicians].

Although there has been a substantial increase in the number of women in medicine, we still find strong gender differences in career patterns. Female physicians specialize to a lower degree than their male colleagues do, although the percentage who do so has increased in recent years. The gender difference in frequency of specialization is not an effect of female physicians' spending a longer time on specialist training. Our results indicate that female physicians, to a greater extent than their male colleagues have to choose between family and career. A larger percentage of female than of male physicians live alone, perhaps indicating that career demands a higher price for the former. However, the percentage of singles is, larger among older than among younger female physicians. We interpret this as indicating that the necessity to choose between career and family is not as strong as it used to be.

Adult↗
PubMed2006

Resident care needs and work stressors in special care units versus non-specialized long-term care units.

Differences in how elderly residents' care needs affect staff's experiences of work stressors between special care units (SCUs) for dementia and psychiatric residents and non-SCUs were investigated. The data were drawn from 390 staff members in 38 long-term care SCUs, and 587 staff in 53 non-SCUs in Finland. Residents' care needs were based on the Resident Assessment Instrument (RAI) system measured by the Minimum Data Set 2.0. Work stressors (time-pressure and role-conflicts) were assessed with a staff survey questionnaire. Multiple-group regression analysis showed that residents' dependency in activities of daily living (ADL) was related to increased work stressors only in SCUs. A high proportion of behavioral problems was related to fewer work stressors for SCU staff, but more for non-SCU staff. Work stressors may be reduced by specializing, so that residents with similar care needs are placed together and care is focused.

Activities of Daily Living↗
PubMed2006

[Location of mechanical ventilation in the specialized centre--intensive care unit, respiratory intermediate care unit and the specialized normal ward].

Until recently "mechanical ventilation" meant "intensive care unit (ICU)". Important arguments for more flexibility concerning the locality where patients are mechanically ventilated are the increase in number of patients, costs and reduced resources. The pulmonary centre for mechanical ventilation, where ICU, respiratory intermediate care unit (RICU) and the specialized normal ward are complementary, is an attractive option for the future. The RICU is the key player in this concept, since as a step down unit it represents a cost-effective approach to the care of substantial numbers of selected patients requiring specialized respiratory care, e. g. intensive respiratory monitoring and therapy, particularly those requiring prolonged mechanical ventilation and non-invasive mechanical ventilation. Success of the RICU requires an experienced team, adequate location and high quality of technical equipment, experienced team, adequate location and high quality of technical equipment.

Costs and Cost Analysis↗
PubMed2002

Educational issues in clinical pharmacology: who are our audiences and what are their specialized needs? One specialized need: "understanding the role of veterinary medicine in public health".

When considering educational issues and the need to update the curriculum for clinical pharmacologists for the new millennium, a number of questions must be raised. Who are our audiences? What are the specialized needs? This educational article identifies the audience, which includes those with diverse degrees such as MDs, PhDs, PharmDs, RNs, DVMs, and other non-MD prescribers working in academia, industry, clinical research organizations, and government in multifaceted disciplines requiring a knowledge base of physiology, pharmacology, biochemistry, anatomy, microbiology, pathology, medicine, and the drug development process of preclinical and clinical studies complete with protocols, pharmacokinetics, and statistics. One specialized current educational issue for clinical pharmacologists to understand is the impact of animal therapeutic and subtherapeutic use of antimicrobials on antibiotic use in human medicine.

Animal Diseases↗
PubMed2005

Transition planning for youth with special health care needs: results from the National Survey of Children with Special Health Care Needs.

OBJECTIVE: To describe the proportion of youth with special health care needs (YSHCN) who are receiving services for medical transitions and to describe which sociodemographic and health care-related factors are associated with receiving transition services. METHODS: We analyzed responses to questions about medical transitions from the 2001 National Survey of Children With Special Health Care Needs (NS-CSHCN). Parents or guardians of youth aged 13 to 17 years who screened positive for the survey were asked (1) whether they had discussed with health care providers how their child's health care needs might change in adulthood, (2) if they had a plan to address these changing needs, and (3) if their child's health care providers had discussed having their child eventually see a doctor who treats adults. Bivariate and multivariate associations were estimated to identify sociodemographic and health care factors related to receiving medical-transition services. RESULTS: Overall, 50% of respondents had discussed their child's changing health care needs with their physicians, although significantly fewer Hispanic youth compared with other youth reported these discussions. Youth who met criteria for a medical home were more likely to have discussed changing needs and to have a plan addressing these needs. Of those who had discussed changing needs, 59% had a plan to address these needs and approximately 42% had reported discussing shifting care to adult-oriented providers. Younger teens and non-Hispanic black children were less likely to have discussed changing providers. Fifteen percent of YSHCN met the Maternal and Child Health Bureau's core outcome for medical transitions. A multivariate logistic-regression model found that older age and having a medical home were significantly associated with increased odds of meeting the outcome measure. CONCLUSION: The proportion of YSHCN meeting the medical-transition outcome measure is quite low, particularly for youth from ethnic minorities. Higher rates are seen for older teens and those receiving care within a medical home. Significant efforts will be required to meet the proposed goal of all YSHCN receiving the services necessary to transition to adult health care.

Adolescent↗
PubMed1991

Special conditions: modified Boeing Model 767-200 and -300 series airplanes; installation of a medical oxygen system utilizing liquid oxygen--Federal Aviation Administration. Final special conditions; request for comments.

These special conditions are issued to E-Systems for design of Civil Reserve Air Fleet aeromedical evacuation ship set kits used to modify Boeing Model 767-200 and -300 series airplanes. Removal of existing passenger seats and installation of the kit will result in these airplanes being equipped with an aeromedical evacuation interior that can accommodate up to 111 litter patients and their attendants. The aeromedical evacuation ship set kit includes an additional oxygen system, utilizing liquid oxygen for storage, that provides medical oxygen for the litter patients. The applicable regulations do not contain adequate or appropriate safety standards for the design and installation of liquid oxygen systems. These special conditions contain the additional safety standards which the Administrator considers necessary to ensure that the design and installation of the liquid oxygen system is such that a level of safety equal to that intended by the applicable regulations is provided.

Aircraft↗