A population history of North America. [Review of: Haines, M.R. and Steckel, R.H., ed. A population history of North America. New York: Cambridge U. Pr., 2000].
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Eleven neurologists (the Collaborative Group) from 7 Latin American countries interviewed 73 of their peers (respondents) with a questionnaire containing points on history-taking, investigations performed, and treatment. The obvious methodological pitfalls of this method are discussed. It was felt, nevertheless, that with judicious interpretation of the answers a fair reflection of reality can be obtained. Items in the history which are less frequently enquired for were alcohol intake just before a stroke, known abnormalities in the blood picture, and intermittent claudication. Amongst less frequently performed investigations were Doppler study of carotids, angiography, lumbar puncture, echocardiography ordered without the indication of a cardiologist, and EEG. Regarding treatment, steroids were preferred by a large majority in the treatment of cerebral oedema. In other items two thirds or more of respondents reached agreement except when dealing with high blood pressure on admission, the use of aspirin in acute ischaemic non-cardiogenic stroke and the use of anticoagulants in stroke considered to be progressing. No differences by country or years of experience were found. The management of affluent and poorer patients was more even than might be expected, most telling differences being CT scanning and anticoagulation.
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PURPOSE: To assess the screening efficacy and practical use of two portable devices to detect moderate to severe visual field loss rapidly in population screening. METHODS: Henson visual field analysis and Damato campimetry for glaucoma were performed in a healthy adult population, to determine false-positive rates; in established glaucoma patients and suspects, to determine false-negative rates; and in a general adult population, to assess practical use in actual screenings. RESULTS: There were no false-positive test failures among the 82 normal subjects who completed the Henson two-step screening. Eighty of 83 normal subjects passed Damato campimetry, resulting in a false-positive rate of 3.6%. Among 83 glaucoma suspects and patients, the Henson test identified 49 (84%) of 58 subjects whose full-threshold fields from Humphrey perimetry were abnormal, 38 (97%) of 39 of whom had moderate to severe visual field loss. The Damato campimeter detected 55 (81%) of 68 subjects with any pathologic loss on full-threshold visual fields, 44 (92%) of 48 of whom had moderate to severe visual field loss. Among 1,278 subjects tested in general population screenings, 55 subjects (4.3%) failed either or both tests. CONCLUSIONS: The Henson visual field analyzer can discriminate moderately to severely diseased from normal visual fields with high sensitivity and specificity. The Damato campimeter can reliably detect moderate to severe visual field loss with a tolerably low false-positive rate. To overcome the weakness of glaucoma screening by tonometry alone, some forms of visual field testing may be acceptably brief (cost effective) and accurate (sensitive and specific).
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Antimicrobial resistance results in increased morbidity, mortality, and costs of health care. Prevention of the emergence of resistance and the dissemination of resistant microorganisms will reduce these adverse effects and their attendant costs. Appropriate antimicrobial stewardship that includes optimal selection, dose, and duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of resistance among microorganisms. A comprehensively applied infection control program will interdict the dissemination of resistant strains.
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Antimicrobial resistance results in increased morbidity, mortality, and costs of health care. Prevention of the emergence of resistance and the dissemination of resistant microorganisms will reduce these adverse effects and their attendant costs. Appropriate antimicrobial stewardship that includes optimal selection, dose, and duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of resistance among microorganisms. A comprehensively applied infection control program will interdict the dissemination of resistant strains.
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