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PubMed1998

Foot problems associated with older patients. A focused podogeriatric study.

The authors report on a 3-year prospective program that included foot-health education and an initial assessment of foot problems in an older population. The program represents a cooperative effort by the Philadelphia Corporation for Aging and the Pennsylvania College of Podiatric Medicine to enhance the quality of life of older citizens. The results show that foot problems are prevalent among older patients. The program also refined a protocol that can be applied in other settings.

Aged↗
PubMed1993

Reversal of female sterilisation: outcome of 210 referrals.

AIMS: To determine the outcome of request for reversal of sterilisation and to compare demographic and social factors of women who subsequently withdrew their request with those who proceeded with the reversal assessment and operation. METHODS: Information relating to the sterilisation and regret intervals were sought from 210 women. Demographic and social factors were recorded and the outcome of the reversal request determined. Patients who withdrew or were deferred/declined were compared on relevant factors with the group who proceeded to, or are still planning, the reversal operation. RESULTS: Ninety-two (44%) withdrew before or during the assessment phase. Another 13 withdrew after laparoscopy identified a poor prognosis. Three declared their intention not to conceive after they underwent the reversal operation. To date, 83 have had surgery with the cumulative intrauterine pregnancy rate at 1, 2 and 3 years being 0.46, 0.62 and 0.78 respectively. In comparing those women who proceeded and withdrew, there were no differences in mean age at referral, age at sterilisation, the number of living children nor marital status. The regret interval prior to referral was significantly longer in the women who proceeded (27.9 and 19.5 months respectively, p = 0.03). Those who were highly motivated in their reversal request were also more likely to proceed (p = 0.003). CONCLUSIONS: There is a large dropout rate of women who seek a reversal of sterilisation. Women who regret sterilisation may have sought sterilisation as a solution to problems that were psychosocial rather than contraceptive in nature. We stress the importance of counselling for both sterilisation and its reversal, since in the latter many developmental personality and relationship problems remain unresolved.

Adult↗
PubMedDate not supplied

Evaluation of a bayesian pharmacokinetic program for phenytoin concentration predictions in outpatient population.

The present work evaluates the performances of a Bayesian program (PKS) for phenytoin concentration predictions in an outpatient population. The retrospective study involved 19 epileptic adults receiving oral phenytoin. The program was used to predict estimated serum concentrations from 0, 1, 2 or 3 feedback concentrations. Measurements of prediction bias (ME) decreased as soon as one steady-state concentration (Css) was used for estimations. Precision (MAE) was significantly improved with 1 Css and was even better and stable with 2 and 3 Css. Likewise, RMSE (composite of bias and precision) regularly decreased when the number of Css used increased. On a clinical way, 12% of the estimations were unacceptable (prediction error > 5 mg/l) with 1 Css and less than 3% with 2 or 3 Css. This number of rejected estimations increased to 45% when no feedback concentration was used. Besides, the program was able to predict important rises of serum levels in spite of relative low increase of the dose when 1 Css at least was known. Thus, the phenytoin dosing program has acceptable performances when at least 1 Css is known, and represents a potential tool to assist the clinician in the particular condition of outpatient population.

Adolescent↗
PubMed1993

VISION USA--optometry's national charity program.

BACKGROUND: There are an estimated 18 million uninsured working Americans and their families who are unable to afford the cost of eye care. These individuals often fall between the cracks of government and private health care assistance. Members of the American Optometric Association have developed the VISION USA program to provide free eye care to those who might otherwise not receive it. METHODS: Nearly 8,000 doctors of optometry nationwide have volunteered to provide free eye examinations in their offices for VISION USA patients. Patients are screened for eligibility and matched to the nearest available participating doctor using a computerized ZIP code matching system. Examinations are usually provided each year during March in observance of Save Your Vision Week. RESULTS: In the first three years of the program, services have been provided to over 115,000 individuals. For over 21 percent of the patients seen, this was their first eye examination ever. More than 86 percent of the patients had one or more vision problems. More than 70 percent were given new or updated prescriptions. CONCLUSION: The VISION USA program is helping to meet a significant unmet need for eye care which exists within a segment of the American population. The program is an outstanding example of the willingness of doctors of optometry to give back to their communities, and to those in need, some of what they have gained from the practice of their profession.

Adolescent↗
PubMedDate not supplied

Childlessness, subfertility, and infertility in Tanzania.

This study examines the trends and variations in childlessness, subfertility, and infertility in Tanzania according to data from the 1973 National Demographic Survey and the 1991-92 Demographic and Health Survey. Between the surveys, the proportion of women older than 30 who were childless was found to have declined more than 60 percent, and the proportion with an open birth interval extending for longer than five years was reduced by 40 to 50 percent in each standard five-year age group from 20 to 39. Within Tanzania, both childlessness and infertility are higher among urban than rural residents, and a substantial range prevails across eight rural zones. Finally, evidence suggests that the decline in impaired fertility has been followed by an increase in the total fertility rate. The difficulties of implementing population policies that aim simultaneously to control population growth and to improve women's health are discussed.

Adolescent↗
PubMed1997

Multiple von Neumann computers: an evolutionary approach to functional emergence.

A novel system composed of multiple von Neumann computers and an appropriate problem environment is proposed and simulated. Each computer has a memory to store the machine instruction program, and when a program is executed, a series of machine codes in the memory is sequentially decoded, leading to register operations in the central processing unit (CPU). By means of these operations, the computer not only can handle its generally used registers but also can read and write the environmental database. Simulation is driven by genetic algorithms (GAs) performed on the population of program memories. Mutation and crossover create program diversity in the memory, and selection facilitates the reproduction of appropriate programs. Through these evolutionary operations, advantageous combinations of machine codes are created and fixed in the population one by one, and the higher function, which enables the computer to calculate an appropriate number from the environment, finally emerges in the program memory. In the latter half of the article, the performance of GAs on this system is studied. Under different sets of parameters, the evolutionary speed, which is determined by the time until the domination of the final program, is examined and the conditions for faster evolution are clarified. At an intermediate mutation rate and at an intermediate population size, crossover helps create novel advantageous sets of machine codes and evidently accelerates optimization by GAs.

Algorithms↗
PubMed1998

Improved birth outcomes associated with enhanced Medicaid prenatal care in drug-using women infected with the human immunodeficiency virus.

OBJECTIVE: To evaluate the effectiveness of an intervention designed to enhance Medicaid prenatal care in improving birth outcomes of drug-using women infected with the human immunodeficiency virus (HIV). METHODS: Medicaid and vital statistics records were linked for 353 HIV-infected drug-using women delivering in 1993 and 1994 while enrolled in New York State Medicaid. Of these, 68% were treated by providers participating in the Prenatal Care Assistance Program, designed to provide case management, improved continuity, referral services, and behavioral risk reduction counseling. In a series of logistic models, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of low birth weight (less than 2500 g) and preterm delivery (before 37 weeks), comparing women using and not using the program. RESULTS: Women using the Prenatal Care Assistance Program were significantly less likely, after adjustments were made for maternal characteristics, to have low birth weight infants and preterm deliveries (OR 0.52, 95% CI 0.31, 0.89; and OR 0.57, 95% CI 0.34, 0.97, respectively). Adding measures of greater adequacy and continuity of prenatal care to the models explained just over 20% of the Prenatal Care Assistance Program's protective effect. The addition of maternal high-risk behavior, HIV-focused care, and drug use treatment variables altered program effect estimates less profoundly (together accounting for 4 and 9% of the program's protection against low birth weight and preterm delivery, respectively). CONCLUSION: The Prenatal Care Assistance Program appeared to be successful in reducing the incidence of low birth weight and preterm delivery in this high-risk population. The program's success can be attributed, in part, to increased adequacy and continuity of prenatal care and, to a lesser extent, to more frequent receipt of special services and reduced maternal high-risk behaviors.

Adult↗
PubMed1980

Exposure to a rural population in a rural residency training program.

Previous reports of rural training programs conducted by medical schools have not examined the relationship between the population residing in an area and the population receiving medical services through the clinical training program. In the present study rural household survey data were compared with patient encounter data from a rural ambulatory cliinic engaged in training Family Practice residents from the Texas Tech University School of Medicine. Clinic patients were found to resemble the rural population subgroup that visits a physician at least once a year. Wide variations in individual clinical experiences were observed when health problems and conditions encountered by residents were compared with problems encountered in the clinic as a whole. In light of current national efforts to increase medical care access in unserved and underserved populations, the demographic findings raise questions concerning appropriate patient exposure goals in clinical training programs.

Adolescent↗
PubMed1987

Growth-associated traits in parental and F1 populations of chickens under different feeding programs. 3. Eating behavior and body temperatures.

In two experiments, parental populations of chickens and their F1 crosses were fed ad libitum or on alternate days. Eating and drinking behaviors, ability to compensate for fasting, and surface and cloacal temperatures were measured. Genetic and environmental (due to fasting) differences in feeding and drinking behaviors were found. Chicks from lines selected for larger body weight were better able to compensate for a 24-hr fast than those selected for smaller weight. Crosses were similar to the parental line that was the better compensator. Correlations between surface temperatures and body weights were consistently positive.

Animals↗
PubMed1979

Age effect hearing levels for a white nonindustrial noise exposed population (ninep) and their use in evaluating industrial hearing conservation programs.

A nonindustrial noise exposed population (NINEP) describing age effects for white males and females has been established that can be used as a reference in evaluating an industrial noise exposed population (INEP) data base. In making this comparison, it is desirable to match the two populations properly with respect to sex, race and age characteristics. Since there presently does not exist an equivalent black NINEP, it is necessary to first isolate the data representing the black population from the industrial sample. A definite learning curve exists in industrial audiometric data bases, with the degree of learning dependent upon the effectiveness of the hearing conservation program. Therefore, this variation must be considered when attempting to compare the industrial audiometric test data with the white NINEP data base presented herein.

Adolescent↗
PubMed1982

Physiological observations in essential hypertension.

The various mechanisms that may be involved in essential hypertension are discussed, as well as their therapeutic implications. A step-care treatment program has been shown to be effective not only for the treatment of the individual patient with mild hypertension but also in mass population treatment programs. It is based on a program of sound general medical care, including dietary sodium restriction, reduction of excess body weight, and pharmacologic therapy. With intelligent use of anti-hypertensive drugs for effective control of arterial pressure, a drastic reduction in cardiovascular morbidity and mortality can be expected.

Coronary Disease↗
PubMed2000

The UCSF post-baccalaureate reapplication program: a preliminary report.

The University of California San Francisco School of Dentistry initiated a pilot project in 1998 to assist economically and/or educationally disadvantaged students to gain admission to dental school. Students entering the program have completed the requirements for admission to dental school, have applied, and been denied admission, and have expressed a desire to care for underserved populations. The program features a summer preparation course for the Dental Admission Test (DAT), learning skill workshops, seminars, and assistance in the reapplication process. The students participate in clinical clerkships and during the fall and spring semesters are enrolled in upper-division and graduate-level science courses at a local university. Five students participated in the pilot project in 1998; they were admitted in 1999 and have successfully completed the first year of dental school. The sixteen students enrolled in 1999 have now been admitted to one or more dental schools. Fourteen students are currently enrolled in the 2000/2001 academic year program.

Clinical Clerkship↗