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At least 379 records · Page 21Linked to original sources
PubMed2003

Compensation for musculoskeletal disorders in Quebec: systemic discrimination against women workers?

Criteria for evaluating workers' compensation claims for occupational disease are strongly linked to medical expertise as supported by scientific study, yet decision-makers are not necessarily familiar with the meaning of these studies. While this is a problem for all claimants, who bear the burden of proving that work caused their injury, the adverse impact of misunderstanding of scientific data can have particular consequences for women, whose work more often appears to be benign. This article reports on a study of empirical data drawn from analysis of 314 workers' compensation appeal tribunal decisions on compensation claims, in Quebec, for musculoskeletal disorders alleged to be related to repetitive work. The study considers randomly selected decisions rendered between 1994 and 1996 on diagnoses of tendonitis, epicondylitis, and carpal tunnel syndrome and, in a follow-up, looks at significant legal decisions by the same tribunals, rendered over a longer period (1987-96). Results indicate that women workers are significantly less likely than their male counterparts to have their occupational disease claims accepted by the appeal tribunal. Evidence suggests that inappropriate overreliance on scientific studies for adjudication purposes contributes to a greater rate of refusal of claims by women workers.

Adult↗
PubMed2003

[Renovascular hypertension in childhood].

Renovascular hypertension constitutes a small percentage of cases of secondary hypertension in childhood. It has to be diagnosed because it is potentially curable. The definition of hypertension in France is based on a study involving 17067 children which analysed the normal distribution of blood pressures from the ages of 4 through 18. Based on these data, different levels of blood pressure are defined: normal blood pressure, borderline hypertension, confirmed hypertension and life threatening hypertension. The confirmation of a renovascular disease as the cause of a child's hypertension is based on the elevation of the peripheral plasma renin level, the captopril tests, possibly the renal vein renin determinations and the imaging studies. The medical management is based on the use of antihypertensive drugs: diuretics, calcium-channel blockers, beta blockers, a blockers, converting-enzyme inhibitors and angiotension II receptor antagonists. The treatment of childhood hypertension has been hampered by several factors: a lack of extensive scientific data and manufacturer's recommendations regarding the doses and pharmacokinetics, a lack of age-appropriate drug formulations and the lack of official authorization for the prescription of most of the antihypertensive drugs in children.

Adolescent↗
PubMed2006

The ADA perspective.

BACKGROUND: The American Dental Association (ADA) has long relied on available scientific evidence in its commitment to use credible scientific data and analyses in policy-making, and its communications with the dental profession and the public. OVERVIEW: The evidence-based dentistry (EBD) process is a systematic approach that reviews and publishes the evidence relevant to specific clinical questions. The goal of this process is to help practitioners provide patients with quality oral health care. The ADA has developed a strategic plan of EBD initiatives and activities in order to increase the knowledge base and improve educational programs; to encourage significant collaboration on EBD-related issues from interested organizations, specialty groups, and various outside agencies; and to increasingly derive the best scientific evidence for use in clinical practice in concert with professional judgment and patient treatment preferences. CONCLUSION: The ADA endeavors to provide relevant information that can assist dentists in translating systematic-review findings and implementing an evidence-based approach in everyday clinical practice. This supports the Association's goal to continue supporting the best available evidence to assist health care teams in the provision of quality patient care and preventive techniques that improve oral health care outcomes.

American Dental Association↗
PubMed1997

Athletic head injuries.

Recent studies have shown a decrease in mortality from head and neck injuries, especially in American football. This has resulted from rule changes and their enforcement, equipment modification, improved coaching and training techniques, and educational programs for neck injuries. Morbidity data, however, are not as complete, particularly as they apply to concussion, the most frequent type of head injury in contact sports. Questions on this condition that still need to be answered before a sound medical disposition can be made are the possible cumulative damage from repeated concussions, and whether one concussion renders a player more susceptible to a second. Currently, decisions on when to allow a football player to return to a game or participate in future contests are arbitrary and based primarily on the experience of the team physician. Certainly, further studies are essential before these decisions can be based on sound scientific data. Thus, the pioneer work of Richard Schneider needs to be continued.

Athletic Injuries↗
PubMed1996

The Chernobyl accident and radiation risks: dynamics of epidemiological rates (morbidity, disability and death rates) according to the data in the national registry.

Ten years have elapsed since the Chernobyl accident. The gravest technologically generated accident throughout human history has attracted considerable attention from the whole world community. At the same time, the problem of estimating the total damage to life and health of people exposed to radiation remains very complicated. The negative effects of Chernobyl include a spectrum of factors which may reinforce each other. In particular, to date there are no theoretical models or practical recommendations on estimating the contribution of the social, psychological or emotional factors that surround diseases due to radiation accidents. On the other hand, for maximum effective rehabilitation of the affected population, the impartial determination of the contribution by both radiation and non-radiation components is necessary. Therefore, the continuation of long-standing investigations within the framework of the National and Radiation and Epidemiological Registry along with obtaining new scientific data in the field of radiation epidemiology is of great practical importance in limiting the health consequences of the accident.

Adolescent↗
PubMed2004

Epidemiology of peptic ulcer disease in Wuhan area of China from 1997 to 2002.

AIM: To describe the epidemiological features of peptic ulcer disease in Wuhan area during 1997-2002, to analyze the sex, age and occupation characteristics, as well as the geographic distribution of peptic ulcer disease, and to determine the effective methods of preventing and controlling peptic ulcer disease. METHODS: In the early 1980s, the peptic ulcer disease registry system was established to collect the data of peptic ulcer disease in Wuhan area. Here we performed a statistically detailed analysis of 4876 cases of peptic ulcer disease during 1997-2002. RESULTS: The morbidity of peptic ulcer disease between males and females was significantly different (chi(2) = 337.9, P<0.001). The majority of peptic ulcer diseases were found at the age of 20 to 50 years. Because of different occupations, the incidence of peptic ulcer disease was different in different areas. CONCLUSION: The incidence of peptic ulcer disease is highly associated with sex, age, occupation and geographic environmental factors. By analyzing the epidemiological features of peptic ulcer disease, we can provide the scientific data for prevention and control of peptic ulcer disease.

Adolescent↗
PubMedDate not supplied

[Reviewing the initial plans for the teaching of pharmacology: quality vs. quantity of knowledge, hesitation is no longer possible].

Pharmacology is located at the intersection of several branches of medical education. This position and the exponential development of medical knowledge, constrains university professors of pharmacology to make teaching choices, since time-limited education is imposed in this subject. Thus, it is necessary to list specific educational objectives within a frame of well defined and clear hierarchized pharmacological concepts. General and practical pharmacology teaching is to be preferred since it provides the knowledge base for further acquisition of specialized pharmacology. The necessary data can be easily and rapidly taught by means of clinical observations and case reports in connection with basic pharmacological concepts and therapeutic strategy. The medical student has to acquire rational guidelines for proper drug monitoring. He also has to learn how to assess the efficacy of the prescribed treatment and how to supervise the compliance. When an adverse effect is observed, the future physician must be able to evaluate the benefit-risk ratio. Initiation into the analysis of published clinical trials is the best way to develop a critical sense. Concurrently, pharmacology teachers should make available technical and practical resources to facilitate access to updated scientific data.

Drug Prescriptions↗
PubMed1990

Antiulcer therapy: an exercise in formulary management.

The purpose of formulary management is to contain costs while preserving quality care. A pharmacy cost review can identify key areas where limiting the agents used could lower costs. H2-receptor antagonists represent such agents. At UC Davis Medical Center, H2-receptor antagonists were found to be one of the highest-cost drug groups in the hospital. Seventy percent of H2-receptor antagonist use was for intravenous prophylaxis of stress ulcer. After a committee review of available data, H2-receptor antagonists were considered therapeutically equivalent. Cimetidine was chosen as the primary H2-receptor antagonist because of an estimated 36% cost savings. Inpatient H2-receptor antagonist use changed from 90% ranitidine prior to the decision to 90% cimetidine after the decision. A monitoring program revealed that there were similar numbers of elevated drug levels for theophylline, phenytoin, and lidocaine before and after the programmatic change. There was no difference in numbers of patients with theophylline toxicity on cimetidine or ranitidine. The incidence of bleeding from stress ulcer was 1.4% in the year following the change to cimetidine use. With aggressive review and utilization of scientific data, cost-saving H2-receptor antagonist restriction decisions can be made that do not compromise quality care.

Anti-Ulcer Agents↗
PubMed2003

A randomized trial of colpopexy and urinary reduction efforts (CARE): design and methods.

The primary aim of this randomized clinical trial is to evaluate whether a standardized modified Burch colposuspension, when added to planned abdominal sacrocolpopexy for the treatment of pelvic organ prolapse, improves the rate of urinary stress continence in subjects without preoperative symptoms of stress urinary incontinence. Secondary aims include comparison of immediate and short-term complications, overall urinary tract function, and other aspects of pelvic health between subjects with and without a concomitant Burch. The value of preoperative urodynamic testing with prolapse reduction will also be compared between subjects with and without a concomitant Burch. This trial is performed through the Pelvic Floor Disorders Network, which is funded by the National Institutes of Health-National Institute of Child Health and Human Development. Subjects will be enrolled at seven clinical centers across the United States and data will be analyzed by the central data coordinating center. Standardized questionnaires and physical observations and measurements will be obtained. The surgical team is masked to the preoperative urodynamic findings, and the patient and research coordinator are masked to treatment assignment. The primary outcome will be determined at 3 months after surgery. Stress continence is defined as absence of stress incontinence symptoms by questionnaire, a negative standardized stress test, and no treatment for stress incontinence other than the study intervention. Additional follow-up occurs at 6, 12, and 24 months. Accrual began in April 2002 and is projected to take 3 years. As of March 6, 2003, 91 patients have been randomized. This article highlights the scientific aspects of trial design for this pivotal clinical trial. The optimal approach to the urinary tract in women treated surgically for prolapse is not known. This trial is designed to provide pelvic surgeons and their patients with scientific data regarding the utility of urodynamics with and without prolapse reduction and the role of colposuspension with sacrocolpopexy.

Female↗
PubMed2006

[Democracy and science advice: the case of environmental health risks].

Science advice, in the context of environmental health, is an activity consisting in bringing together and evaluating available scientific data at a given moment on a particular question or concern regarding the hazardous nature of an agent or substance--whether it be of a physical, chemical or microbiological nature. Science advice also relates to assessing health risks linked to the quality of the environment, in vue of rendering this information useful to those in charge of decision making and risk management. Naturally, many groups are interested by a potential hazard or risk, and they all would like to effectively intervene over the course of the process in order to influence the decision or measure taken. In this article, the author recalls that risk is an entity which is both scientific and political by nature. Hence, this demand is well founded. Nevertheless, he proposes and explicates a series of different steps, whether concurrent or successive, throughout the entire process of science advice in support of decision-making on matters related to environmental risk. He justifies why hazard and risk assessment, followed by risk analysis, requisites a clear delineation of the roles of the various actors so that their own responsibilities could be clearly attributed. The "procedural" approach of science advice, which is more and more frequently implemented within international expert groups in the international arena, satisfactorily achieves the target of objectivity, transparency and accountability.

Decision Making↗
PubMed1993

Public beliefs about the amount of fiber in foods.

Despite the current interest in fiber in foods and dietary recommendations to increase fiber consumption, relatively little attention has been paid to public beliefs about fiber in foods. We used a mail questionnaire in a sample of 478 adults to assess public beliefs about the amount of fiber in 40 different foods and compared these beliefs with laboratory data about fiber content. Almost all respondents had heard of both fiber and roughage, and many (40%) believed that fiber and roughage were different concepts. Most respondents rated the amount of fiber in the 40 foods similarly to actual fiber content. Few differences in beliefs about fiber in foods existed among demographic groups. Factor analysis of the ratings of the 40 foods revealed three underlying dimensions: 1) fruits and vegetables, 2) animal products, including meat and dairy foods, and 3) grains, including breads and cereals. These findings reveal that some people believe that fiber differs from roughage, but their beliefs about the amount of fiber in foods matches fairly well with scientific data about fiber content. Nutritionists may benefit from assessing beliefs about concepts such as fiber and roughage before attempting to change food consumption behaviors.

Demography↗
PubMed2000

[The future of the German language in science].

The German language served the scientific community for decades during the 20th century. The shift to the English language was considered by some as a loss of cultural identity. A view difficult to support, since not only Germany but also countries like Switzerland and Austria are part of the cultural heritage. The development of the impact factor, which is derived predominantly from Anglo-American journals, has also contributed to this situation. This may be of concern, since it influences the scientific future of young scientists from German-speaking countries. At present, no exclusively German-language journal in obstetrics and gynecology is listed in the Index Medicus anymore. If this means that the German-language scientific journals are not needed for the transmission of scientific data, they may evolve as organs for postgraduation studies. Interest in postgraduate papers only recently became evident in academic circles. In American CVs a rubric of postgraduate studies is separately provided. These are highly esteemed. The need for such postgraduate journals will be established when postgraduate studies become mandatory also in German-speaking countries. A lack of postgraduate papers may be overcome by an impact factor for postgraduate studies to encourage young academics to write such papers. Until German-language postgraduate papers are submitted in larger numbers, the editors of German-language journals are referred to the Anglo-American literature where such articles are available. Since a scientific journal, even when there are large subscription numbers, requires advertisements of the pharmaceutical industry, there is a potential for a conflict of interest between physicians and advertisers. In general, it can be expected that the number of German-language journals will drastically decline.

Cultural Characteristics↗
PubMed1993

Overlooking ethics in the search for objectivity and misconduct in science.

The author investigates the relationship between the reliability of scientific data and the ethics of the scientist, demonstrates how attention given to misconduct in the biological sciences adversely affects the broader significance of ethics in this field, and extracts from the applications of ethics in medicine perspectives relevant to the biological sciences. As twentieth-century biological scientists applied increasingly powerful methods to diminish bias and to improve the objectivity of their work, including the replication of experimental findings to verify them, they came to believe that these methods would protect their studies from error and misleading conclusions. This assumption has been shown to be unwarranted because it cannot protect scientists from self-conscious or biased selection in reporting evidence. The canons of scientific objectivity must be grounded in something more fundamental--the canon of ethics. In the end, a commitment to the ethical standard of truthfulness, through an understanding of its meaning to science, is essential to enhance objectivity and diminish bias. Unfortunately, the ethos of concern for scientific misconduct continues to dominate the research-ethics movement. This focus is damaging because it turns the attention to seeking and finding wrong-doers and determining punishment rather than discussing generic issues of doing the right thing, preventing harms, seeking benefits, and understanding the right-making and wrong-making characteristics of actions. The focus on scientific misconduct makes ethical issues appear synonymous with legal issues and the search for ethical understanding synonymous with carrying out an investigation.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomedical Research↗
PubMed1996

Comparison of four human studies of perinatal exposure to methylmercury for use in risk assessment.

Newer data from human epidemiologic studies of methylmercury (MeHg) poisoning in which perinatal exposure occurred are available from four distinct populations. The results of an Iraqi grain-consuming population are compared to results from studies performed in fish-consuming groups in the Faroe Islands, the Seychelles Islands and in Peruvian fishing villages. A comparison of the results indicate that the Iraqi population does not represent a sensitive subpopulation within a perinatal group, but rather the relative lower threshold identified from this study was the results of confounders. Use of this benchmark dose for regulatory purposes may place a severe limitation upon fish consumption in the United States that is not fully supported by the scientific data.

Denmark↗
PubMed1993

CDC WONDER: a comprehensive on-line public health information system of the Centers for Disease Control and Prevention.

OBJECTIVES: CDC WONDER, a comprehensive on-line public health information system of the Centers for Disease Control and Prevention (CDC), was developed to place timely, action-oriented information in the hands of public health professionals. METHODS: A unified system was developed de novo to be used for and to evolve along with public health. All data are stored and updated on the CDC mainframe. RESULTS: CDC WONDER provides menu-driven access to 24 databases with information on mortality, hospital discharges, cancer incidence, notifiable diseases, acquired immunodeficiency syndrome, the Morbidity and Mortality Weekly Report, etc.; each database has on-line documentation. Results can be tabulated and graphed, and there is full-text searching of textual databases. Non-CDC staff have access via telephone connection. From August 1991 through June 1992, system databases were accessed 10,698 times, and there were 842 users (mean of 97 new users per month). CONCLUSIONS: CDC WONDER has shown that it is possible to build a large, on-line database of scientific data for public health professionals. CDC WONDER provides a common foundation from which to build information-based public health plans and policy and could help strengthen the public health system.

Centers for Disease Control and Prevention, U.S.↗
PubMed2006

Cardiovascular support in preterm infants.

BACKGROUND: Despite increasing investigation in the area of cardiovascular instability in preterm infants, huge gaps in knowledge remain. None of the current treatments for hypotension, including the use of inotropic agents, have been well studied in the preterm population, and data regarding safety and efficacy are lacking. Thus, the labeling information regarding the use of inotropes as therapeutic agents in this population is inadequate. OBJECTIVE: This article reviews the current deficiencies in knowledge with respect to measuring and achieving normal organ perfusion; summarizes the clinical, methodological, and ethical issues to consider when designing trials to evaluate medications for hemodynamic instability in the preterm neonate; and proposes 2 possible trial designs. Unanswered questions and potential obstacles for the systematic study of drugs to treat cardiovascular instability in preterm neonates are discussed. METHODS: The neonatal Cardiology Group was established in 2003 by the US Food and Drug Administration (FDA) and the National Institute of Child Health and Human Development (NICHD) as part of the Newborn Drug Development Initiative. The Cardiology Group conducted a number of teleconferences and one meeting to develop a document addressing gaps in knowledge regarding cardiovascular drugs commonly used in low-birth-weight neonates and possible approaches to investigate these drugs. This work was presented at a workshop cosponsored by the NICHD and the FDA held in March 2004 in Baltimore, Maryland. Information for this article was gathered during this initiative. RESULTS: To develop rational, evidence-based guidelines corroborated by robust scientific data for cardiovascular support in newborns, well-designed and adequately powered pharmacologic studies and clinical trials are needed to evaluate the safety and efficacy of inotropic agents and to determine the short- and long-term effects of these drugs. Trials investigating the currently available and novel therapies for cardiovascular instability in neonates will provide information that can be incorporated into product labeling and a scientific framework for cardiovascular management in critically ill neonates. The Cardiology Group identified and prioritized 2 conditions for investigation of therapeutic options for the management of neonatal cardiovascular instability: (1) cardiovascular instability in preterm neonates; and (2) cardiac dysfunction in neonates after cardiopulmonary bypass surgery. Key research questions in the area of cardiovascular instability in the preterm infant include determining optimal blood pressure (BP) in preterm infants; identifying better measures than BP to determine organ perfusion; optimizing hemodynamic treatments; and clarifying any associations between BP or therapy for low BP and mortality, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity, and neurodevelopmental outcome. The Cardiology Group concluded that the study of inotropic agents in neonates using outcomes of importance to patients will require a complicated trial design to address the elements discussed. The group proposed 2 clinical trial designs: (1) a placebo-controlled trial with rescue therapy for symptomatic infants; and (2) a targeted BP trial. CONCLUSION: This summary is intended to stimulate and assist future research in the area of cardiovascular support for preterm infants.

Cardiotonic Agents↗
PubMed2002

Reinforcing flood-risk estimation.

Flood-frequency estimation is inherently uncertain. The practitioner applies a combination of gauged data, scientific method and hydrological judgement to derive a flood-frequency curve for a particular site. The resulting estimate can be thought fully satisfactory only if it is broadly consistent with all that is reliably known about the flood-frequency behaviour of the river. The paper takes as its main theme the search for information to strengthen a flood-risk estimate made from peak flows alone. Extra information comes in many forms, including documentary and monumental records of historical floods, and palaeological markers. Meteorological information is also useful, although rainfall rarity is difficult to assess objectively and can be a notoriously unreliable indicator of flood rarity. On highly permeable catchments, groundwater levels present additional data. Other types of information are relevant to judging hydrological similarity when the flood-frequency estimate derives from data pooled across several catchments. After highlighting information sources, the paper explores a second theme: that of consistency in flood-risk estimates. Following publication of the Flood estimation handbook, studies of flood risk are now using digital catchment data. Automated calculation methods allow estimates by standard methods to be mapped basin-wide, revealing anomalies at special sites such as river confluences. Such mapping presents collateral information of a new character. Can this be used to achieve flood-risk estimates that are coherent throughout a river basin?

Climate↗
PubMed1993

The motion analysis system for dynamic gait analysis.

The research value of the Motion Analysis System, within its scope of limitations, is large and may allow the podiatrist to lend scientific data to support many areas that have been previously held to be of a theoretic or anecdotal basis. The whole concept of rearfoot control with orthoses is perhaps the most important of these. Podiatrists have been aware of the role of orthoses for years, but now there is the means to demonstrate these findings to other medical professions. The ability to compare a number of clinical variables is another truly useful feature. The Motion Analysis System and other similar equipment are not designed to replace or make obsolete the biomechanical examination and "trained human eye;" rather, they act to compliment these skills and to help bring the realm of podiatric biomechanics and orthotic therapy into the scientific arena.

Foot↗