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PubMed1992

Assessment of severity and change in obsessive compulsive disorder.

Useful clinician-rated measures of OCD are now available. The Y-BOCS and NIMH Global OC both seem suitable for monitoring outcome in drug trials of OCD. These two scales seem relatively specific for symptoms of OCD and are sensitive to drug-induced changes in symptoms. Neither the Y-BOCS nor the NIMH Global OC confuse trait with state. There are ample data suggesting that the Y-BOCS is reliable and valid scale. Unlike some of the symptom inventories, such as the LOI and MOCI, final scores on the NIMH Global OC and Y-BOCS are not influenced directly by the type or number of obsessions and compulsions present. A computer-administered version of the Y-BOCS has been developed. Currently available patient-rated instruments suffer from serious shortcomings, including insensitivity to change and poor representation of patients with mono-symptomatic clinical pictures (e.g., hoarding alone). Some rating scales have been adapted for use in children with OCD. Several groups, including our own, have elected to use change scores on the 10-item Y-BOCS and a global measure of OCD, such as the NIMH Global OC or modified OGI, as the principal outcome variables in drug trials in patients with OCD. Several studies have selected a 35% decrease in Y-BOCS scores from baseline as indicative of clinically significant improvement. A limitation of all single-item global measures is that they cannot be resolved into smaller components. The more fine-grained analysis that is possible with the multi-item Y-BOCS makes it more desirable as a primary outcome measure, with a global scale as a secondary outcome measure.

Adult↗
PubMed2004

Redefining competition in health care.

The U.S. health care system is in bad shape. Medical services are restricted or rationed, many patients receive poor care, and high rates of preventable medical error persist. There are wide and inexplicable differences in costs and quality among providers and across geographic areas. In well-functioning competitive markets--think computers, mobile communications, and banking--these outcomes would be inconceivable. In health care, these results are intolerable, with life and quality of life at stake. Competition in health care needs to change, say the authors. It currently operates at the wrong level. Payers, health plans, providers, physicians, and others in the system wrangle over the wrong things, in the wrong locations, and at the wrong times. System participants divide value instead of creating it. (And in some instances, they destroy it.) They shift costs onto one another, restrict access to care, stifle innovation, and hoard information--all without truly benefiting patients. This form of zero-sum competition must end, the authors argue, and must be replaced by competition at the level of preventing, diagnosing, and treating individual conditions and diseases. Among the authors' well-researched recommendations for reform: Standardized information about individual diseases and treatments should be collected and disseminated widely so patients can make informed choices about their care. Payers, providers, and health plans should establish transparent billing and pricing mechanisms to reduce cost shifting, confusion, pricing discrimination, and other inefficiencies in the system. And health care providers should be experts in certain conditions and treatments rather than try to be all things to all people. U.S. employers can also play a big role in reform by changing how they manage their health benefits.

Delivery of Health Care↗
PubMed1992

A nutrition survey of and recommendations for individuals with Prader-Willi syndrome who live in group homes.

The purpose of this study was to describe anthropometric data and identify diet-related problems of individuals with Prader-Willi syndrome (PWS) who reside in group homes. A group home is a licensed foster care facility that provides 24-hour care for the developmentally disabled. Questionnaires were sent to dietitians (or the person responsible for nutrition care) of 25 group homes; responses from 18 homes were analyzed. The mean age of residents with PWS was 25 +/- 8.4 years and the mean height was 152.4 +/- 9.7 cm. The mean weight for 19- to 22-year-old men was 75.5 +/- 26.8 kg and that for women of the same age was 74.5 +/- 20 kg. The residents consumed a mean of 1,000 to 1,500 kcal/day. Most of the group homes (n = 16) locked their kitchens at night, and in 12 of the homes stealing and hoarding of food occurred. Pica behavior (eating of nonfoods) was reported in 7 homes. One third of all residents had success in weight loss and were on a maintenance diet, but a major problem was determination of a desirable weight goal. Our key recommendations for dietitians are weigh residents weekly; use the body mass index with prescribed zones for determination of weight goals; monitor change in circumference measurements; follow the guidelines of 7 to 8 kcal/cm of height for weight loss and 10 to 14 kcal/cm of height for weight maintenance; administer 1,000 kcal/day or more and encourage daily aerobic exercise; respect food preferences while adhering to dietary prescriptions; adhere to strict food control procedures; and use nutrition education methods and an interdisciplinary approach for behavior modification.

Adolescent↗
PubMed2006

No scalpel vasectomy advocacy and community mobilisation--a personal experience.

The so called myths and taboos among the people of India are obstactes controlling population explosion and thereby the nation is being handicapped with economic development. To propagate awareness and information, the NSV Resource Center took up organising mega camps for the acceptance of NSV as the method of family planning and male participation. The awareness material has been developed to bring forth total sociocultural transformation through development of intense desire, strong determination, effective management and inclusion of a zeal of perpetual efforts both among the promoters and acceptors. The information modules have been developed to suit the requirements of various vehicles through which the message has to be spread. Awareness messages are generated through the inputs from sociocultural, economic, ethical, hygienic and administrative acumen. The materials prepared are disseminated through display hoardings, wall writings, distribution of pamphlets, audiovisual clips, face to face counselling, etc. Communication technology serves mobilising and educating people, especially rural populace. Some steps are suggested to reach remotest villages which are elaborated. Counselling is an essential part of motivation to the client. During the last 5 years a significant surge has been noticed in terms of access to new communication technologies. This may be employed to successfully implement the family planning programme.

Awareness↗
PubMed1990

Species-specific changes in the metabolic control of food intake: integrating the animal with its environment.

Research on the metabolic control of feeding has been almost exclusively restricted to the study of laboratory rats. This poses no problem if all animals respond to metabolic challenges similarly; however, they do not. Unlike rats, Syrian, Turkish, and to a lesser degree, Siberian hamsters do not increase their food intake following food restriction. It has been argued that hamsters do not increase their food intake following a fast in laboratory tests because in their natural habitat they presumably would have a hoard of food in their burrows to buffer them from any shortfalls in the food supply above ground. An alternative hypothesis is proposed based on the self-imposed fast that occurs during a bout of hibernation in hamsters and the subsequent absence of compensation of food intake upon arousal. This fixed rate of feeding during the hibernation season may facilitate utilization of their food cache. Therefore, it may be that the failure to increase feeding following an experimenter-induced fast in the laboratory is due to the expression of this fixed pattern of feeding that normally accompanies hibernation. The relationship between food restriction and reproductive status is also discussed in terms of species- and gender-specific responses. Hamsters also differ from rats in that they do not increase their food intake following severe alterations in carbohydrate metabolism (via acute injections of 2-deoxy-D-glucose (2DG) or insulin), lipid metabolism (via administration of the fatty acid oxidation blocker methyl palmoxirate (MP), or from alterations in both (via combined administration of MP and 2DG). Perhaps food intake in hamsters is controlled by the waxing and waning of inhibitory rather than stimulatory factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Our race to the future.

The need for mosquito control is documented from history books with comments about hoards of mosquitoes, deaths from mysterious high fevers, and yellow fever, malaria and dengue. The paper traces the birth of mosquito control in the United States to the present time with a look into the future. Regulations are discussed and their effect on mosquito control methods. Public education and training of personnel is mentioned. The author's opinion of AMCA's role in the future of mosquito control and research is one of prominence and leadership.

Forecasting↗
PubMed1989

Coprophagy in young laboratory rat.

Coprophagy (ingestion of maternal faeces) was found in young laboratory rats between the ages of 16 and 28 days. The degree of this activity during the given period was not constant; a multiple increase on about the 25th day was followed by an abrupt drop and complete cessation coincided with the time of spontaneous weaning. Coprophagy did not appear in prematurely weaned young (at 16 days) which were given faeces and was protracted in undernourished young whose weaning time was prolonged. Young weaned rats without having ingested maternal faeces displayed relative hyperphagy for solid food. This early hyperphagy had later consequences for the feeding behaviour of adult males, which looked for food and consumed it more intensively in a new environment and also hoarded it. Defensive behaviour was not affected.

Animals↗
PubMed1983

Drugs taken by a population based sample of subjects 65 years and over in New Zealand.

Drug taking by a population based sample of 559 subjects aged 65 years and over was investigated. The median number of drugs prescribed for those 65-79 years was 1.5 drugs per subject and for those 80 years and over was 2.1 drugs per subject. In those 80 years and over, over 30% were taking diuretics, over 20% were taking digoxin and over 30% were taking psychotropic drugs. Analysis of those taking six or more drugs showed that the number of drugs prescribed could be reduced by avoiding duplication of drugs with similar action, avoiding unnecessary drugs and avoiding drugs of no proven value. The majority of subjects knew the purpose of their medications, were able to read the prescription instructions and complied with these instructions. Sharing and hoarding of tablets were uncommon.

Aged↗
PubMed1980

Estimating the effect of child mortality on the number of births.

This article rigorously derives the properties of the regression of births on child deaths. It is shown how the raw regression coefficient may be corrected for the effects of fertility on mortality so that the rate at which dead children are replaced may be estimated. The method is applied to data from Colombia. It is found that the mortality rate differs across individuals and is correlated with fertility. Such conditions vitiate the use of birth intervals and parity progresssion ratios yet can be dealth with using the new method. On average each death produces 0.2 new births as a direct result of the death. Fertility hoarding may raise the total fertility response to roughly one-half birth per death.

Attitude↗
PubMed1993

Effects of response strategy and retention interval on performance of Clark's nutcrackers in a radial maze analogue.

Two groups of Clark's nutcrackers (Nucifraga columbiana) were trained to use either a stay or shift response strategy in a radial maze analogue. Each trial had a preretention stage, a retention interval, and a postretention test. In Experiment 1, acquisition with a 5-min retention interval was studied. Response strategy did not affect the rate at which the task was learned. Performance following longer retention intervals was tested in Experiments 2-4. Changes in retention intervals were presented in trial blocks of increasing duration in Experiment 2 and were randomly presented between trials in Experiment 3. Experiment 4 extended the retention interval to 24 hr. No difference in performance was found between the 2 groups in any of these experiments. These results suggest a flexible relationship between spatial memory and response requirement in food-hoarding birds for at least 1 spatial memory task.

Animals↗
PubMed1996

CMPA not alone in pursuing huge reserves, CMAJ survey of US firms reveals.

Although Canada and the US are two separate worlds when medical malpractice is considered, actuaries across North America are looking into their crystal balls in an attempt to set reserves for uncertain future claims. Given the relatively low rate of litigation in Canada, some feel the Canadian Medical Protective Association is hoarding cash as it continues to raise premiums even though it has close to $1 billion in reserves. However, some experts suggest that this is just a prudent way to do business in an unpredictable environment. Milan Korcok looks at the situation facing physicians on both sides of the border.

Canada↗
PubMed1996

A case of the frontal lobe syndrome following head injury in Harare, Zimbabwe.

A 51 year old male, presented with recurrent outbursts of aggression, hypersexuality, sexual indiscretion and hoarding litter following a head injury sustained in a road traffic accident. His premorbid personality was described as energetic but quick tempered. He had no delusions or perceptual disturbances and cognitive functions were intact. Physical and detailed neurological examination were essentially normal, with the exception of disuse atrophy of the lower limb muscles. He lacked insight into his problems. This case illustrates the need for a multidisciplinary approach to assessment, management and rehabilitation of such cases.

Accidents, Traffic↗
PubMed1996

[Characteristics of dementia patients with hyperphagia].

Research into dementia has tended to concentrate on memory loss and other cognitive impairment, but attention has recently turned to the associated psychiatric symptoms and behavioral abnormalities. Among them, increases in the amount eaten or hyperphagia are not uncommon in dementia. This problem is of clinical importance since it not only jeopardizes patient's health, but also is a cause of caregiver burden. The aim of this study was to assess the prevalence of hyperphagia in dementia. Additionally, possible mechanisms underlying this problem were reviewed and related to the demographic data, cognitive function test, radiological findings and other psychiatric symptoms. Out of a sample of 91 demented inpatients, hyperphagia was present in 30.8%. Hyperphagia was significantly associated with delusion, misidentification, aggressive behavior, hoarding behavior and pica phenomena. But these patients did not show difference in cognitive function, radiological abnormalities, repetitive behavior and depressed mood when compared with other demented patients. The possible etiologies were discussed, including physiological and psychological factors. Hyperphagia is a complex phenomenon, better understanding of the underlying pathogenesis may highlight specific pharmacological or behavioral methods for the management this troublesome behavior.

Aged↗
PubMed1996

Medication-taking behavior of the elderly.

The aim of this study was to examine the medication-taking behavior of older adults living in communities. Factors influencing their medication-taking behavior were also explored. Data were collected by way of a face-to-face interview survey through a random sample of 401 persons over 65 years of age, and were analyzed using SPSS computer software. The sample included two groups of people, one residing in an urban community and the other in a rural community. The results revealed information on the following kinds of medication behavior: self-medication, using non-prescription medications, sharing medication, forgetting to take medications, misusing medications, being non-compliant, using multi-medications, hoarding medications, and combining Western medications with traditional therapies. In comparing the differences between the urban and rural elderly, the urban elderly had more accurate medication knowledge and displayed better medication-taking behavior. An elderly person's age, gender, education level, marital status, living status and health belief were found to affect his/her medication knowledge and behavior. Education of both health care professionals and the general public is urgently needed to ensure the safety of taking medication by the elderly.

Aged↗
PubMed1996

[Modern typology of symptoms and obsessive-compulsive syndromes: results of a large French study of 615 patients].

OBJECTIVES: The most common strategy to search for homogenous subgroups of Obsessive-Compulsive Disorder (OCD) patients has been based on the OCD symptoms themselves as a classifying variables. The purpose of this study was to: expand recognition of major clinical OCD subtypes in a large cohort of patients recruited from the national french survey: "Screening-Understanding-Treating OCD"; reproduce preliminary data coming from a US collaborative study on OCD sub-types [Baer L, J Clin Psychiatry, 1994; 55 (3):18-23]. METHOD: From 731 OCD/OCS (OC disorder or syndromes) patients recruited in the phase 1 of the national french survey, complete collected data on the Y-BOCS Symptom Checklist (YBOCS-CL) were obtained in 615 patients and on the OCD spectrum inventory in 646 patients. Principal components analysis (PCA) was firstly applied on major symptom categories of the YBOCS-CL, and next on each individual symptom. Gender effect on clinical aspects of OCD was also explored by comparative descriptive analysis. RESULTS: The first PCA on major symptoms categories confirmed the grouping of all categories in three major factors, named as following: Facteur 1 = "Predominantly Compulsive" (loaded with items of symmetry, order, hoarding, repeting, counting, checking); Facteur 2 = "Predominantly Obsessive" (loaded with aggression, violent, religious, sexual obsessions) and Facteur 3 = "Mixed" (with contamination and somatic obsessions and washing compulsions). Our data seemed to be very close to US collaborative study that had found in a sample of 107 OCD patients, the presence of the same three major clinical factors. The second PCA applied on all YBOCS-CL individual items had provided interesting items groupings, suggesting a reorganization and re-labelling of YBOCS-CL symptoms categories. Therefore, a new presentation of the YBOCS-CL can be proposed with a more clinical relevance than the original version. Results from OC spectrum inventory showed high comorbidity rate with many of OCD related disorders. Finally, a gender influence on OC clinical manifestations was observed, especially more severity and higher rate of difficult OC-subtypes in male patients. The french national survey data on OC symptoms sub-typing and clustering showed a "natural" groupings of OC symptom categories which add more validity to the subtypes proposed by ICD-10 (based on syndromal predominance : obsessions, compulsions or mixed). These sub-categories are not part of the DSM III-R, neither of the new version of DSM IV!

Adult↗
PubMed1996

A Singapore study of obsessive compulsive disorder.

This is a study of 283 consecutive patients diagnosed as suffering from obsessive compulsive disorder (OCD) who had sought treatment in a private psychiatric clinic. This represents 4.5% of all patients treated in the clinic. Ninety-four percent were Chinese, 3% were Indians and 0.4% were Malays. The mean age of onset of illness was 27, SD 11.9. Fifty-one percent of patients developed their illness prior to age 25. There were more male than female patients. The male to female ratio was 1.4:1. A high percentage of patients had attained higher educational level and were economically active. The main forms of the obsession were idea, impulse and image; and the main contents were contamination, illness, aggression, exactness, sex, death and religion. The main compulsions were cleaning, checking, repetitive behaviour, need for symmetry and precision and hoarding. The co-morbidity diagnoses were depressive, general anxiety, phobia, panic and psychotic disorder. In the patients who were followed-up for more than one year, it was found that 78% improved with treatment given. However, 22% remained unwell or deteriorated. In this series, it was noted that 17% of patients were severely incapacitated by the illness. Six percent had admission to mental hospital and 1% (3 cases) committed suicide.

Adolescent↗
PubMed1997

[Kleptomania: phenomenological, clinical and legal aspects].

Kleptomania is currently classified in psychiatric nomenclature as one of the impulse control disorders (DSM-IV, 1994). It is characterized by repeated failure to resist impulses to steal objects, not for personal use or monetary gain. The objects are therefore discarded, given away, or hoarded (ICD-10, 1992). This disorder is known since the early 18th century from the phenomenological and clinical viewpoints, yet is still debated with regard to therapeutic strategies and criminal liability. Although there are usually complications associated with the legal consequences of being caught and arrested, subjects continue to violate the law despite repeated arrests and convictions. In a 28-year old man suffering from kleptomania, years of psychodynamic psychotherapy were ineffective. Only when he was treated as suffering from an impulse control disorder or a variant of obsessive-compulsive disorder, was there significant improvement. The positive response to buspirone (5-HT1A) augmentation of fluvoxamine (SSRI) suggested that disturbed central serotonergic neurotransmission might play an important role in the pathogenesis of kleptomania. This concept is strengthened by the comorbidity of the syndrome with depression and by its compulsive traits. We stress that although kleptomaniacs cannot differentiate between right and wrong, testing shows that their sense of reality is intact, but they act under the influence of drives they cannot resist.

Adult↗
PubMed2002

Beneficial effect of hyperbaric oxygen on island flaps subjected to secondary venous ischemia.

The potential for hyperbaric oxygen therapy (HBO) to decrease the untoward effects of a secondary ischemic event was studied in the rat superficial epigastric flap model. The secondary venous ischemic flap was created by cross-clamping the vascular pedicles for 2 h. Twenty-four hours later, the flap was reelevated and the venous pedicle was occluded for 5 h. Thirty-two rats were divided into three groups. In experimental group 1, animals received HBO treatment immediately prior to the initial flap elevation and ischemia at 2 atmosphere pressures for 90 min. In experimental group 2, the rats underwent a similar course except for a second 90-min HBO course immediately prior to the secondary venous occlusion. The rats without HBO therapy were used as controls. The results showed that all control flaps were nonviable at 1 week by clinical inspection and fluorescein injection. Complete flap survival occurred in 20% of group 1 flaps and 30.8% of group 2 flaps. Partial flap survival occurred in the rest of the flaps in these two groups, with mean survival areas of 48% and 55%, respectively. In conclusion, HBO treatments significantly increase the survival of flaps subjected to a secondary ischemia, even if administered before the primary ischemia. Administering HBO prior to secondary venous ischemia was marginal, which may be due to the effect of O(2) given by HBO not lasting longer than 5 h.

Animals↗