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PubMed1989

Reducing the radiation dosage in patients with a scoliosis.

A significant number of girls develop an adolescent idiopathic scoliosis and require repeated full-length radiographs of the spine. Since Nash's publication in 1979 [16], there has been considerable concern expressed about protecting them from excessive radiation, and particularly from the development of radiation-induced breast tumours. We present a study which compares the differences in radiation dose using different techniques, specifically, the use of a posteroanterior projection, very fast rare earth screens and progressive wedge-shaped filtration. The use of a posteroanterior projection reduced the sternal exposure by 98.9% and the breast skin exposure by 92%. A combination of all three techniques reduced the sternal exposure by 99.5%. We recommend that these should be used routinely to reduce the radiation hazard to children with an adolescent idiopathic scoliosis.

Adolescent↗
PubMed1988

Influence of feminism and professional status upon service options for the battered woman.

This paper reports on a survey of volunteers from domestic violence agencies and social workers throughout one state. Respondents were given a hypothetical case of an abused wife and asked to rate the level of their emphasis upon several services in their work with this woman. The services were divided into two categories: those which focused upon independence and those which focused upon interpersonal dynamics. It was found that feminist ideology and gender were better predictors of emphasis upon independence than either professional status, age, gender, experience with abused wives, or personal history with spouse abuse. The finding that social workers emphasized independence more so than did volunteers ran counter to some concerns expressed in the previous literature.

Achievement↗
PubMed1984

Inhibitory effect of clonidine upon adenylate cyclase activity, cyclic AMP production, and insulin release in rat pancreatic islets.

Conflicting opinions were recently expressed concerning the possible effect of alpha 2-adrenergic agonists upon cyclic AMP production in pancreatic islets. In the present study, clonidine inhibited glucose-induced insulin release from rat pancreatic islets, this inhibitory effect being abolished by idazoxan. Clonidine did not suppress the capacity of forskolin to augment glucose-induced insulin release. In a particulate subcellular fraction derived from the islets, adenylate cyclase was activated by calmodulin (in the presence of Ca2+), NaF, GTP, L-arginine, and forskolin, and slightly inhibited by clonidine. The inhibitory action of clonidine upon basal adenylate cyclase activity was more pronounced in islet crude homogenates. The inhibitory effect of clonidine was antagonized by forskolin whether in the particulate fraction or crude homogenate. At variance with the modest effects of glucagon, D-glucose, L-arginine, or a tumor-promoting phorbol ester upon cyclic AMP production by intact islets, forskolin caused a six-fold increase in cyclic AMP production. Clonidine inhibited cyclic AMP production by intact islets, whether in the absence or presence of forskolin. It is proposed that the inhibitory action of clonidine upon insulin release is attributable, in part at least, to inhibition of adenylate cyclase.

Adenylyl Cyclases↗
PubMed1979

A review of over-the-counter drug therapy.

The authors review the extent of the use of nonprescription drugs as well as possible variables influencing such consumption. Various studies indicate that age, sex, personality characteristics, perceptions of health status, socioeconomic factors, parental example, and pharmacists all play parts in determining over-the-counter (OTC) drug utilization. Several sources express concern about the inaccessibility of accurate OTC drug information to the consumer. Indeed, even the FDA has occasional difficulty obtaining reliable facts on both the numbers and formulae of such products. Several studies indicate that consumers acquire information about their home remedies through advertising, friends and relatives, physicians, pharmacists, and product labels. By far the most influential of these is advertising, and much concern has been voiced over consumers' unquestioning faith in drug ads. Examples are cited of deceptive, inaccurate, and unfair advertising practices used by some OTC drug manufacturers. The pros and cons of the "drug-oriented society" theory are discussed, including an analysis of its underlying origins. Testing of the safety and efficacy of nonrescription remedies has proved to be controversial, especially when considering the ramifications of the placebo effect. Different surveys report widespread misuse of OTC's by consumers through overuse, taking several drugs concurrently, and using home remedies to treat potentially serious diseases.

Adult↗
PubMed1981

New health practitioners in rural satellite health centers: the past and future.

Data from a 1975 and a follow-up 1979 survey of 44 rural, satellite health centers staffed by new health practitioners (NHPs)are compared to determine what changes have taken place in these centers during this period when the number of physicians in the United States has markedly increased. Of the surveyed clinics, 8 closed and 12 converted to having physicians on their staffs by 1979. The remaining 24 NHP-staffed centers realized growth in staff size and budget, patient utilization, and proportion of budget generated by revenues from patients. (Despite these positive changes, most of these 24 clinics expressed concern about their financial situations-a reflection of the considerable room for further improvement.) The general growth of the 24 NHP-staffed satellites, however, was not as substantial as that achieved by the 12 clinics staffed by physicians in 1979. The rapidly increasing supply of physicians in the United States and the potential effects of this trend on NHP-staffed rural satellite centers are discussed. Possible reasons why these satellites may continue to be of value in making primary care available in rural areas are enumerated.

Community Health Centers↗
PubMed1992

Fracture risk as determined by prospective and retrospective study designs.

Both retrospectively and prospectively designed studies consistently show low bone mass and/or bone mineral content (BMC) to be risk factor for low-trauma fractures in postmenopausal women. Along with the reports of such studies there has been concern expressed that BMC measurements overlap between fracture groups, i.e., some women with high BMC develop fractures and some women with low BMC do not. In these commonly used epidemiologic study designs, BMC does not discriminate between those who have and have not experienced the untoward event at some level of the exposure factor. The ability to discriminate is more properly determined by the sensitivity and specificity of the measured value. To contrast the concepts of risk and sensitivity, a nested case-control study was conducted within a 24-year cohort study of women at risk for osteoporosis. We found that for each 1.0 decrement of BMC z-scores, the adjusted relative risk for the prospective study design was 1.67, while the odds ratio obtained from the most recent BMC z-score measurements was 1.87. A receiver operating characteristic (ROC) curve, calculated from the nested case-control study data, showed that BMC z-scores, measured after low-trauma fracture, have both low sensitivity and low specificity to detect existing fracture status.

Adult↗
PubMed1988

[Burden and possibility of respite for family caregivers].

70 family caregivers and non related supporters at home of impaired elderly in urban conditions were interviewed regarding the burdens imposed on them and the kind of relief that would help them. Strain connected with the physical and mental deterioration of the supported and with their insecure future is more often mentioned than physical or financial burdens. The wishes most frequently expressed concern more and better available information, personal counseling, and more substitution in the evenings, night and weekends.

Aged↗
PubMed1999

The family experience of deinstitutionalization: insights from the closing of Central State Hospital.

Since the early 1970s, policy makers and researchers have expressed concern about the potential negative consequences of deinstitutionalization on families. This article summarizes results of a survey of family and lay caregivers of patients discharged from Central State Hospital, which closed in June 1994. The survey was designed to assess the impact of the closing on family members, including their attitudes, caregiving responsibilities, and involvement in the treatment of the patients. Results indicate that family members have mixed feelings about the closure. Family caregivers also reported that they have not been asked to take on significant amounts of the caregiving responsibilities since the clients were moved from the hospital. Family members described a significant reduction in the frequency of contact they had with their loved ones and with professional caregivers since the closure. Implications for behavioral health policy makers considering or planning closing or downsizing long-term care facilities are discussed.

Adult↗
PubMed1999

"Stakeholder" attitudes over time toward the closing of a state hospital.

For four groups--patients (N = 80), their families or lay caregivers (N = 120), hospital workers (N = 124), and the public (N = 108)--attitudes toward the decision to close the only long-term, urban state hospital are traced over time. Initially, patients were most supportive of the closing decision (65.4%), followed by family members (39.8%), the general public (27.8%), and workers (10.4%). A majority of all groups favored fixing the hospital. Almost half of the clients and more than half of other stakeholders expressed concerns about homelessness. Most attitudes were consistent despite respondents' sociodemographic characteristics. The overall profile of group attitudes remained remarkably stable, although there was a good deal of change in individuals' positions. Public support for fixing the hospital decreased significantly, and differences among stakeholders regarding homelessness disappeared. These findings reinforce the importance of ascertaining different constituencies' positions and recognizing the slowly changing response of stakeholders even under massive and successful policy change.

Adult↗
PubMed2000

Office-based methadone prescribing: acceptance by inner-city practitioners in New York.

In the US, methadone maintenance is restricted by federal and state regulations to large specialized clinics that serve fewer than 20% of the heroin-dependent population. In Europe, Canada, and Australia, primary health care providers already are utilized widely as methadone prescribers. In preparation for a limited study of office-based methadone treatment in New York City, 71 providers from 11 sites were surveyed about their willingness to prescribe methadone in their office-based practices. Of the 71, 85% had methadone-maintained patients who came to their practice for other care. One-third felt knowledgeable enough to prescribe methadone, and 66% said they would if given proper training and support (88% among AIDS care providers). Half expressed concern that they might be unable to meet the multiple needs of these patients. With additional training and ancillary support, the 47 providers willing to become methadone providers could serve, at 10-20 patients each, 470-940 patients, a population the size of 3-5 average methadone clinics.

Attitude of Health Personnel↗
PubMed2003

Ultrasound-assisted lipoplasty: a review of over 350 consecutive cases using a two-stage technique.

Ultrasound-assisted lipoplasty (UAL) was developed in Europe and South America. Its introduction into the mainstream of United States surgery in 1997 was initially received with great enthusiasm. Soon, however, anecdotal reports surfaced describing limitations and complications related to the emerging technology. Among the concerns expressed were burns and postoperative seroma formation. The etiology of these complications was speculated to be a result of prolonged ultrasonic energy time. Consequently, some authors recommended limiting the amount of ultrasonic energy time per site and even complete avoidance of UAL in certain body areas. Our review includes over 350 consecutive cases of internal UAL performed by two surgeons utilizing a similar technique. The basic rules of UAL as described by Zocchi were followed without regard to other limitations such as ultrasonic energy site times, body areas, and level of tissue planes. The mechanism of action of UAL and the surgical technique are described. The procedure is a two-stage technique, including tumescent infiltration followed by energy application and simultaneous hollow titanium cannula aspiration. Suction-assisted lipoplasty was not a component of the procedure. The results, including complications, are outlined. Complications were few and not severe. There was no correlation between length of ultrasonic energy time and rate of postoperative complications. The advantages and disadvantages of UAL are discussed. UAL alone is the authors' preferred technique for body contouring to all body areas, except in the female breast.

Adolescent↗
PubMed2004

Shellfish conflict in Baynes Sound: a strategic perspective.

The shellfish aquaculture industry (SAI) has operated in Baynes Sound, British Columbia (BC) since the early 1900s. Recognizing the economic potential of the area, the industry has requested additional farming opportunities. However, Baynes Sound upland residents and many other stakeholders have expressed concerns that SAI activities are having a negative impact on the environment, quality of life, and other nonaquaculture resource uses in the area. In order to address these issues, the Action Plan was initiated by a BC government interagency project team in November 2001. To assist in assessing the strategic aspects of this conflict, the decision support system GMCR II is employed here to apply a new methodology, the graph model for conflict resolution, to systematically analyze the ongoing conflict over shellfish aquaculture development in Baynes Sound within a social, economic, and environmental framework. Valuable insights are procured to guide decision-makers toward sustainability of the shellfish industry.

Animals↗
PubMed1999

Future Land Use and Concerns About the Idaho National Engineering and Environmental Laboratory: A Survey of Urban Dwellers.

/ We examined environmental concerns and future land-use preferences of 487 people attending the Boise River Festival in Boise, Idaho, USA, about the Idaho National Engineering and Environmental Laboratory (INEEL), owned by the US Department of Energy (DOE). We were particularly interested in the perceptions of urban dwellers living at some distance from the facility, since attitudes and perceptions are usually examined for people living near such facilities. More than 50% of the people were most worried about contamination and about waste storage and transport, another 23% were concerned about human health and accidents and spills, and the rest listed other concerns such as jobs and the economy or education. When given a list of possible concerns, accidents and spills, storage of current nuclear materials, and storage of additional nuclear materials were rated the highest. Thus both open-ended and structured questions identified nuclear storage and accidents and spills as the most important concerns, even for people living far from a DOE site. The highest rated future land uses were: National Environmental Research Park, recreation (including hiking, camping, fishing and hunting), and returning the land to the Shoshone-Bannock tribes; the lowest rated future land uses were homes and increased nuclear waste storage. These relative rankings are similar to those obtained for other Idahoans living closer to the site and for people living near the Savannah River Site, another DOE facility in South Carolina. The concern expressed about accidents and spills and waste storage translated into a desire not to see additional waste brought to INEEL and a low rating for using INEEL for building homes.KEY WORDS: Future land use; Perceptions; Recreation; Hazardous waste; Department of Energy; Idaho National Engineering and Environmental Laboratory.http://link.springer-ny.com/link/service/journals/00267/bibs/24n4p532.html</HEA

Journal Article↗
PubMed1998

[Refractive surgery and flight safety].

For both VFR and as IFR flight, visual assessment is the major source of information for the pilot. The new possibilities for change of refraction by means of corneal refractive surgery have led to an increasing demand from pilots for these new methods. Can these methods successfully be applied for aviation purposes? The valid regulations for medical standards of pilots, as well as the future international regulations such as JAR and ICAO, are explained in this respect. A report is given on the work of the Advisory Board of the German Federal Government Air Traffic Authority and on the cases treated so far and their outcome, and recommendations are expressed. Concerning the legal situation and clinical experience, advice for pilots, aviation medical examiners and ophthalmologists is given.

Accidents, Aviation↗
PubMed2001

Anisakis infestation in marine fish and cephalopods from Galician waters: an updated perspective.

A total of 2,673 fresh specimens of cephalopod and fish representing 35 species were obtained from commercial local fisheries in Galician waters (NW Spain). They were examined for anisakid nematodes by digestion of the muscle and elution of the viscera and whole body cavity. All larval nematodes recovered were identified by light microscopy and multilocus electrophoresis as belonging to the species Anisakis simplex sensu stricto and A. pegreffii. Encysted larvae mostly occurred in the viscera but were also found in the flesh of squid and fish. Demographic values for larval nematodes are discussed in relation to host preferences and the ecological niche of both anisakid species at the sampling area. Primary recommendations are also expressed concerning the effects of current fishing and aquaculture practices on the Anisakis problem.

Animals↗
PubMed2004

Interstitial recurrence, with chronic inguinodynia, after Lichtenstein herniorrhaphy.

Not long after Lichtenstein and Shulman (1986) introduced their subaponeurotic repair, Nyhus (1989) expressed concern regarding subprosthetic incarceration. Even though interstitial recurrence was not encountered over the subsequent decade or more, one of us (AIG) was referred three cases over the past 3 years. Two men and a woman suffered from chronic inguinodynia 1-6 years following a Lichtenstein procedure for unilateral primary inguinal herniation. A mass, in an unusual location (spigelian line) was palpated in one, the other two required ultrasound studies for diagnosis. All at surgery revealed indirect sacs, and one also had a separate protrusion in the lateral triangle of the groin. Two were repaired laparoscopically, the other using a bilayer connected prosthetic device. Our hypothesis is that this painful complication is now appearing because of recent modifications to the operative technique. An overlay lax dome-shaped prosthesis cannot be relied on to always initially collapse the inguinal canal. Mini-dissection, by limiting exposure, may prevent placement of the keyhole in the mesh close enough to the internal inguinal ring. Studies are under way to determine the validity of these conclusions.

Adult↗
PubMed2002

Is clozapine cost-effective? Unanswered issues.

The treatment of schizophrenia accounts for approximately 2.5% of national healthcare expenditures, with the majority of this expense concentrated on costly in-patient services. Health policy leaders have expressed concern that these costs create a strain on limited resources. Newer antipsychotic pharmacotherapies, such as clozapine (Clozaril, Leponex; Novartis), may improve patient symptoms and potentially lower hospital use. However, the high cost of these pharmaceutical treatments must be considered alongside any savings in hospital costs and improvement in patient functioning, when assessing the overall economic impact of using such treatment on schizophrenic patients. This review examines six key cost-effectiveness studies that address the economic considerations and quality-of-life issues associated with the use of clozapine in battling the burdens of schizophrenia to determine whether in fact the use of clozapine is clinically and economically appropriate. As such, the review suggests: (a) treatment with clozapine significantly improves patient symptoms and quality of life; (b) patients who receive clozapine experience a reduction in the number of hospitalizations, which can lead to a decrease in hospital costs; (c) treating patients with clozapine shifts the cost structure from in-patient care to outpatient care and drug therapies; and (d) patients who receive clozapine can experience a reduction in overall treatment costs. However, several cost considerations remain unaccounted in most studies, and a serious effort is needed to conduct studies of the vast numbers of outpatients who might benefit from treatment with clozapine.

Journal Article↗
PubMed2006

Climate change, flow regulation and land-use effects on the hydrology of the Peace-Athabasca-Slave System; findings from the Northern Rivers Ecosystem Initiative.

The Northern Rivers Ecosystem Initiative (NREI) was established in the late 1990s to address important science questions resulting from previous studies undertaken by the Northern Rivers Basin Study (NRBS). This manuscript summarizes the results from a number of reports on hydrologic research conducted on the Peace-Athabasca-Slave river and lake systems. Specific concerns expressed by the NRBS and subsequent NREI focused on how these systems were being affected by climate change, flow regulation and land-use changes. Issues addressed in this report include: the fate of aquatic perched basins within the Peace-Athabasca Delta under historical and future climate trends; the sources of major floods that replenish these basins and how the frequency, magnitude and source areas of such events have changed over time; the synoptic weather patterns and atmospheric teleconnections that are responsible for the generation of major snowmelt runoff that drive major floods; the potential effect that climate and land-use changes might have on basin runoff and delta lake levels; the specific hydro-climatic conditions required to produce major ice-jam floods on the Peace River and how these may be altered by climate change; remote-sensing methods to document delta flooding and vegetation change; and the dual effect of climate and flow regulation on the water levels of Great Slave Lake and how these may affect other nearshore processes, particularly wind seiches, that influence flooding of the Slave River Delta. A review of the major findings and recommendations for future research concludes the report.

Canada↗