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PubMed1998

Service-mix in general dental practice in Japan: a survey in a suburban area.

Overseas investigations have reported the amount and variety of dental services provided. An understanding of the current service-mix in private general practice is important in the anticipation of the future practice of dentistry. The main purpose of this study was to describe the service-mix of private general practitioners in Japan, which was recorded using the Australian Dental Association Dental Procedure Code. Some comparisons with previous studies were offered. The youngest age group and adolescents formed only a small percentage of the total patients, while the greatest percentage of patients occurred in the 45-64 year age group. The services provided were mainly restorative, diagnostic advanced restorative and endodontic services. Preventive services represented a minority of dental activity, especially for young patients. Periodontic and orthodontic services were also remarkable for their low percentage in all age groups. In comparison with an Australian study, the percentage of preventive services was considerably lower. Movement toward a preventive emphasis in Japanese dentistry requires a change in the clinical model, de-emphasizing biomedical and aetiological approaches and placing greater emphasis on the patient and factors affecting dental practice.

Adolescent↗
PubMed2000

Serological and virological characterization of clinically diagnosed cases of measles in suburban Khartoum.

Measles continues to be a major childhood disease in terms of global morbidity and mortality. In the main areas of its endemicity the only available means of diagnosis are based on clinical criteria: the presence of a maculopapular rash and fever accompanied by cough, coryza, and/or conjunctivitis. We have studied 38 clinically diagnosed cases of measles in Khartoum, Sudan, by means of serology, reverse transcriptase PCR (RT-PCR) on throat swabs and virus isolation from lymphocytes. On the basis of serology, 28 patients were diagnosed as having an acute measles virus (MV) infection, while in 10 cases the clinical symptoms proved to have other causes. It was shown that in cases with low serum immunoglobulin M (IgM) levels, an additional measurement of IgG or virus-neutralizing antibodies was necessary to discriminate between patients with an acute MV infection sampled during an early stage of the disease and patients who had experienced an MV infection in the more distant past. The serological laboratory diagnosis was validated by an MV-specific RT-PCR: for all confirmed measles cases tested a fragment of the correct size which hybridized with a third MV-specific primer could be amplified, while all serologically negative cases were also RT-PCR negative. MV could be isolated from 17 out of 23 of the serologically confirmed cases, demonstrating that virus isolation is less reliable as a diagnostic tool than serology or RT-PCR. This study stresses the urgent need for a rapid diagnostic field test for measles.

Adolescent↗
PubMed2002

Part time female sex workers in a suburban community in Kenya: a vulnerable hidden population.

BACKGROUND: In sub-Saharan Africa, female sex workers (FSWs) are a vulnerable high risk group for the acquisition and transmission of sexually transmitted infections (STI) and HIV. OBJECTIVES: To study parameters of sexual behaviour and knowledge of STI and HIV, to describe health seeking behaviour related to STI, and to measure the prevalence of gonorrhoea, chlamydia, syphilis, and HIV-1, to provide baseline data for targeted STI and HIV prevention interventions. METHODS: In a cross sectional survey with snowballing recruitment, between February and March 2000, 503 self identified FSWs in a suburb in Mombasa, Kenya, were interviewed with a structured questionnaire and screened for gonorrhoea, chlamydia, syphilis, and HIV-1. RESULTS: The mean number of sexual partners in the previous week was 2.8 (SD 1.6). The mean number of non-regular clients and regular clients in the previous week was 1.5 (1.0) and 1.0 (0.9) respectively. The median weekly income from sex work was $US15. A total of 337 (67%) women had an alternative income in the informal sector. 146 (29%) and 145 (45%) never used a condom with a client and non-paying partner respectively. The prevalence of gonorrhoea, chlamydia, and syphilis was 1.8%, 4.2%, and 2.0% respectively. The overall HIV-1 seroprevalence was 30.6%. CONCLUSIONS: There is a large need for intensive STI and HIV prevention interventions in part time FSW.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Impact of establishing a primary stroke center at a community hospital on the use of thrombolytic therapy: the NINDS Suburban Hospital Stroke Center experience.

BACKGROUND AND PURPOSE: To increase the proportion of ischemic stroke patients treated with thrombolytic therapy, the establishment of primary stroke centers in community hospitals has been advocated. We evaluated the use of thrombolytic therapy before and after institution of a primary stroke center in a community hospital. METHODS: The availability of an on-call stroke emergency response team was the only significant additional resource required for this hospital. All eligible patients were treated with intravenous tissue plasminogen activator (tPA). The number of patients with cerebrovascular disease, number and proportion of patients treated with tPA, times to treatment, and patient outcomes were recorded during the first 2 years of the stroke center. RESULTS: During the 12 months before institution of the stroke center, 3 ischemic stroke patients (1.5%) were treated with tPA. During the 2-year period of around-the-clock coverage, 44 of 420 ischemic stroke patients (10.5%) were treated with intravenous tPA, a significant increase in tPA use (P<0.0001). CONCLUSIONS: Establishment of a primary stroke center at a community hospital resulted in a substantial increase in the proportion of patients receiving thrombolytic therapy for ischemic stroke. If this experience is generalized, the beneficial impact of primary stroke centers on stroke outcomes and costs to the healthcare system may be substantial.

Adult↗
PubMedDate not supplied

Community assessment in a suburban Hispanic community: a description of method.

The Hispanic population is growing rapidly and is composed of individuals from many countries with varying levels of acculturation, education, income, and citizenship status. The Genesis Health and Empowerment Program was developed locally in 1993 to improve the health status of Hispanics living in Des Plaines, Illinois, USA. Understanding the quality of life and its cultural patterning for the community is an essential aspect of planning and implementing a health care delivery program. Using Leininger's Theory of Culture Care: Diversity and Universality as a framework, adapted the Concerns Report Method was essential for data collection. This paper describes the method used for learning about the Hispanic community. Steps included conducting three focus groups, constructing a structured interview guide, collecting data, analyzing data, and reporting the findings to the community. Some very preliminary findings are presented and implications for transcultural health care are described.

Adolescent↗
PubMed2005

Nonoperative treatment of fifth metatarsal fractures in an orthopaedic suburban private multispeciality practice.

BACKGROUND: The purpose of this study was to review consecutive fifth metatarsal fractures in the author's (KFK) practice from August, 1999, to November, 2003. METHODS: During this period 64 patients (66 fractures; 35 tuberosity fractures, 10 Jones fractures, three stress fractures, two segmental shaft fractures and 16 oblique distal shaft/neck fractures) were treated nonoperatively. Initial treatment was started from the day of injury to as long as 8 weeks after injury. All patients were treated ambulatory with immediate weightbearing. RESULTS: The time to bony union averaged 3.7 months. The union rate was 98.5% with a satisfaction rate of 100%. CONCLUSIONS: By using closed treatment techniques bony union was predictable with minimal cost and a high satisfaction rate. We recommend nonoperative treatment of fifth metatarsal fractures for patients in whom the time to return to full activities is not critical.

Adolescent↗
PubMed2006

A longitudinal approach to assessing urban and suburban children's exposure to pyrethroid pesticides.

We conducted a longitudinal study to assess the exposure of 23 elementary school-age children to pyrethroid pesticides, using urinary pyrethroid metabolites as exposure biomarkers. We substituted most of the children's conventional diets with organic food items for 5 consecutive days and collected two daily spot urine samples, first morning and before bedtime voids, throughout the 15-day study period. We analyzed urine samples for five common pyrethroid metabolites. We found an association between the parents' self-reported pyrethroid use in the residential environment and elevated pyrethroid metabolite levels found in their children's urine. Children were also exposed to pyrethroids through their conventional diets, although the magnitude was smaller than for the residential exposure. Children's ages appear to be significantly associated with pyrethroids exposure, which is likely attributed to the use of pyrethroids around the premises or in the facilities where older children engaged in the outdoor activities. We conclude that residential pesticide use represents the most important risk factor for children's exposure to pyrethroid insecticides. Because of the wide use of pyrethroids in the United States, the findings of this study are important for both children's pesticide exposure assessment and environmental public health.

Age Factors↗
PubMed1999

Infant pulmonary hemorrhage in a suburban home with water damage and mold (Stachybotrys atra).

The American Academy of Pediatrics recently issued guidelines regarding the potential toxic effect of indoor molds. We now report another case of an infant with pulmonary hemorrhage whose residential environmental assessment revealed the presence of the toxigenic mold Stachybotrys atra. We used a questionnaire to identify environmental factors that could predispose the home to fungal contamination. We collected air samples from multiple locations in the home that we felt would reflect areas of relevant exposure. Surface samples were collected with a piece of transparent tape for semiquantitative measurement of spores present. We classified spores into their respective genera based on shape, size, and color. We also measured mycotoxin levels. Air sampling revealed significantly elevated total spore counts in the patient's bedroom and in the attic. Aspergillus/Penicillium species were predominant. Stachybotrys spores were found in the air sampled in the patient's bedroom, as well as from surfaces sampled in the patient's closet and the attic ceiling. Additionally, a small patch of Stachybotrys-contaminated area in the closet ceiling was sent for mycotoxin analysis. This material proved to be highly toxigenic. As the link between the presence of Stachybotrys in the home and pulmonary hemorrhage in infants increases, further efforts should be made to educate physicians, health care providers, and new parents about the potential toxic effects of this mold.

Air Pollution, Indoor↗
PubMed2005

The potential of comprehensive sex education in China: findings from suburban Shanghai.

CONTEXT: More and more Chinese adolescents are engaging in premarital sexual activity. As a result, the numbers of unplanned pregnancies and sexually transmitted infections (STIs) among Chinese young adults have increased markedly. METHODS: A comprehensive sex education program, including information on abstinence, contraception and healthy sexual behaviors, was carried out in a suburb of Shanghai. The program used six methods for providing information and services to unmarried 15-24-year-olds over a period of 20 months. Sexual behavior surveys were conducted among intervention participants and among controls in a comparable town, who did not receive a similar intervention; chi-square tests and logistic regression were used to compare the results. RESULTS: Participation in the intervention was not associated with delayed sexual initiation, but was associated with reduced odds that youth coerced a partner into having sex (odds ratio, 0.3) and with increased odds of contraceptive use (6.2) and condom use (13.3) during the intervention period. The greater the level of participation, the larger the protective effects. Furthermore, the proportion of youth reporting pregnancy involvement during the intervention period was significantly lower in the intervention group than among controls (19% vs. 26%). CONCLUSION: Comprehensive, community-based interventions may be effective in reaching large numbers of Chinese youth and in promoting sexual negotiation, contraceptive use, and pregnancy and STI/HIV prevention.

Adolescent↗
PubMedDate not supplied

Hepatitis in 101 consecutive suburban cocaine and opiate users.

The records of 101 cocaine and/or heroin drug abusing patients admitted consecutively to Fair Oaks Hospital were evaluated for history of IV drug abuse, antigen and serum antibody evidence of hepatitis A and B infection, and elevation of serum SGPT. One patient, an IV user, had hepatitis B antigen present in his blood. No patient had acute hepatitis A (IgM) antibody present. Forty-five out of fifty-three (84.9%) IV abusers were Hep B Ab positive, while two out of twenty-nine non-IV abusers (6.9%) were positive. Twenty of fifty-three (43.4%) IV users had positive hepatitis A Ab while one of twenty-nine (3.4%) of non-IV users were positive. Thirty-five of fifty-five (63.6%) IV users had elevated SGPT compared to five of forty-one (12.2%) in non-IV users. IV users tended to be older than non-IV users. The data presented in this article indicate that there is a greatly increased incidence of both hepatitis A and B in IV drug users compared to non-IV users and that the hepatitis B incidence is increased in a far greater amount than could be expected in a normal population. The type of drug injected (heroin, other opiates, or cocaine) was not an important determinant. The presence of hepatitis B antibodies in any drug abusing patient who denies IV use is a strong indication that they may not be telling the truth about their past drug abuse. It makes little difference whether drug abusing patients live in the inner city or the suburbs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Ethnic differences in the utilisation of public psychiatric services in an area of suburban Melbourne.

OBJECTIVE: The main aim of this study was to compare levels of service use by English and non-English speaking background people. METHOD: A comparison of service use in 1991/1992 between clients of English speaking (ESB) and non English-speaking (NESB) background was undertaken using hospital inpatient statistics, community mental health centre contact data, interpreter usage figures, and the 1991 Australian census. RESULTS: The main findings indicated: (a) longer median lengths of stay of NESB than ESB inpatients; (b) roughly equal involuntary hospitalisation rates between ESB and NESB residents, but significantly lower rates of voluntary hospitalisation for NESB residents; (c) NESB face-to-face clinic contacts significantly shorter (by between five to ten minutes) than ESB; and (d) variable and generally low use of interpreters. No significant associations between ethnicity, legal status and gender were found. There were limitations in the available data and conclusions could be drawn only with caution. CONCLUSIONS: Recommendations include better routine collection of ethnically relevant information, and measures designed to improve the acceptability and accessibility of inpatient services.

Adolescent↗