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Smoking habits of secondary school boys in rural Riyadh.

OBJECTIVE: To estimate the prevalence of smoking among Saudi rural secondary school students and to explore their attitudes towards smoking. DESIGN: A cross-sectional study was conducted during May and June 1993, using a modified and translated version of the World Health Organization (WHO) standard questionnaire for the survey of smoking. Six rural male secondary schools near Riyadh were randomly selected, and 358 students representing half of the classes were included. RESULTS: Current smokers represented 17% of the students. The most common reasons for smoking were desire (32%), idleness (28%), imitation (22%) and enjoyment (20%). The majority knew about and understood the hazards of smoking. Around half of the smokers had started the habit before the age of 15. The media were the primary source of knowledge about smoking hazards for 66% of students; doctors (45%) and educators (30%) had a less significant role. Religion was the most important reason for not smoking among non-smokers. Financial reasons were less important (11%), probably reflecting the relatively cheap price of cigarettes. CONCLUSION: The size of the smoking problem is big enough to be considered a warning of an impending epidemic. Schools should have a greater role in health education. The government should adopt a policy of regular increases in cigarette taxes to cover part of the cost of treating smoking-related diseases.

Adolescent↗

Umbilical and epigastric hernia repair.

The repair of umbilical and epigastric hernias still represents a challenge to surgeons. Although a common and relatively simple procedure, there is no exact protocol today on how the repair should be done. The Mayo technique and its alterations could not stand the test of time: a recurrence rate of 20% and higher is not acceptable for any surgical procedure. Although there is no consensus opinion, one thing is clear: the importance of an anatomic repair without tension and without an artificial enlargement of the defect. In 1987 Lichtenstein reported on 6321 cases of herniorraphy with a tension free repair, and in 1994 Stuart reemphasized that special importance in his editorial in the Lancet. A newer study from Brancato and coworkers in Italy also states the advantage of a tension-free prosthetic repair in 16 patients with epigastric hernia. We have gone even further and recommend a tailored-to-the-patient repair using a customized polypropylene mesh and a one-layer running suture. The advantages should be obvious: no artificial creation of an even bigger than original defect, a completely tension-free repair, and little to no recurrence of the hernia. Our results clearly prove that assumption. Moreover, the procedure is extremely safe and complications are very rare and minor. We conclude that using a mesh plug in a customized tension-free repair of umbilical and epigastric hernia shows many advantages over the commonly used methods. And we finally conclude with the words of Albert Einstein: "The only source of knowledge is experience."

Digestive System Surgical Procedures↗

The foundation of Piaget's theories: mental and physical action.

Piaget's late theory of action and action implication was the realization of a long history of development. A review of that history shows the central place of action in all of his theoretical assertions, despite the waxing and waning of other important features of his theories. Action was said to be the primary source of knowledge with perception and language in secondary roles. Action is for the most part not only organized but there is logic in action. Action, which is at first physical, becomes internalized and transformed into mental action and mental representation, largely in the development of the symbolic or semiotic function in the sensorimotor period. A number of alternative theories of cognitive development place primary emphasis on mental representation. Piaget provided it with an important place as well, but subordinated it to mental action in the form of operations. In this, as Russell claims, he paralleled Schopenhauer's distinction between representation and will. Piaget's theory of action was intimately related to the gradual development of intentionality in childhood. Intentions were tied to actions by way of the conscious awareness of goals and the means to achieve them. Mental action, following the sensorimotor period, was limited in its logical form to semilogical or one-way functions. These forms were said by Piaget to lack logical reversibility, which was achieved only in the sixth or seventh year, in concrete operations. Mental action was not to be fully realized until the development of formal operations, with hypothetical reasoning, in adolescence, according to the classical Piagetian formulation. This view of the child's logical development, which relied heavily on truth-table (extensional) logic, underwent a number of changes. First from the addition of other logics: category theory and the theory of functions among them. In his last theory, however, an even more radical change occurred. With the collaboration of R. Garcia, he proposed a logic of meanings that would require a recasting of his earlier truth-table-based operatory logic that he claimed explained the development of logical thought and problem solving. The new logic of meanings, influenced by Anderson and Belnap's (1975) logic of entailment, placed new emphasis on inferential processes in the sensorimotor period, introduced protological forms in the actions of the very young child, and proposed that knowledge has an inferential dimension. The consequence was that the late theory shifted emphasis to intentional (qualitative) logic and meaning from the earlier extensional (quantitative) logic and truth testing. The profound changes in Piaget's late theory requires a serious reevaluation of Piaget's entire corpus of research and theory; a task which is yet to be done. Seen in a new light, the late theory is much closer to intellectual currents associated with hermeneutic and semiotic traditions in their concern with meaning and interpretation and less, if at all, with truth. This, despite Piaget's couching of the new theory in a logical mode. The late theory added significant new elements to the theory of action and action-implication, and suggest that Piaget's, and his collaborator's, new research data, which were interpreted within the new theoretical framework, require corroboration and review. The question as to whether Piaget's assertions are at root metaphorical and lack psychological reality, which has followed his theories from its earliest days, arises as well with the assertions of the late theory. Possibly, even more so, since even a limited historical review of his theories points to a considerable concurrence between changes in the fundamental assumptions of his theories and intellectual currents of the times. In hindsight, Piaget's theories appear as "works in progress," down to his last theory. Yet, even in the end, he charted the direction of possible further progress.

Child↗

North and South: bridging the information gap.

Information exchange is critical for development of health systems. The information needs of less-developed countries are especially challenging, but many factors inhibit free flow of knowledge. There is much talk about how technical fixes--such as the internet--might fill this information gap. Yet few attempts have been made to ask clinical investigators who work in resource-poor regions for their views on these difficulties and the possible solutions. The messages reported here, from a survey of Lancet editorial advisors, suggest that information, research, and publication capacities are intimately linked. Investigators, publishers, editors, and editorial organisations all have important parts to play in solving this global information poverty.

Africa↗

Health practices, problems, and needs in a population of Micronesian adolescents.

Saipan, one of many islands of the Pacific Trust Territory, depends on the United States for its medical care. The limited resources on the island have resulted in little medical attention for adolescents. This study surveyed 519 Saipan adolescents to determine their health practices, problems, and needs. Although these teenagers rarely saw physicians, they commonly reported health problems such as headaches, abdominal pain, and dental cavities. In the psychosocial arena, their problems involved parents, girlfriends/boyfriends, school, and suicidal thoughts. The health topics found to be of most interest included sex education, jobs, suicide prevention, drugs, and birth control. The most popular methods for learning about these subjects were books, movies, films, and school classes. There were high reported incidences of drug and alcohol problems among boys, and thoughts about suicide in all respondents.

Adolescent↗

Factors influencing breast-feeding among adolescents.

During a 15-month study period, 244 adolescent mothers under 18 years of age were surveyed, of whom 53% elected to breast-feed. A subset of 60 primiparous breast-feeding adolescents were studied regarding the influence of several factors on the duration of breast-feeding. An attitude questionnaire was administered in the hospital within 48 hours of delivery. Follow-up interviews were obtained by telephone or in person at approximately 2 weeks and 2 months after birth. Eighty-three percent made the decision to breast-feed before the third trimester. Thirty-five percent discontinued breast-feeding within the first postpartum month, the most common reason being "nipple confusion" in the infant; 22% nursed for more than 1 month but less than 2 months, and 43% breast-fed for 2 months or more. None of the variables examined (maternal age, ethnic group, education level, involvement of the baby's father, timing of the breast-feeding decision, intended duration of breast-feeding, age at which formula supplementation was started, or availability of maternal support) was predictive of the duration of breast-feeding. Contrary to adolescent stereotypes, 65% of mothers chose breast-feeding because it was "good for the baby," and 67% identified the "closeness" of the nursing relationship as the most enjoyable part of breast-feeding. Twenty-eight percent cited modesty issues about breast-feeding as the greatest disadvantage, and 17% returned to work or school within the first 2 postpartum months, posing additional obstacles to breast-feeding. Our data suggest that adolescents are receptive to breast-feeding, but they may require close follow-up and anticipatory guidance tailored to their individual needs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Experts' opinions on the profile of optimal care for patients with diabetes mellitus type 2 in the Netherlands.

BACKGROUND: The St. Vincent Declaration has resulted in discussions and initiatives on optimal diabetes care during recent years. Both are based on two sources of knowledge: evidence and experience. We wanted to reveal the experience based knowledge in the Netherlands to identify essential elements or prerequisites for high quality type 2 diabetes care. METHODS: A group of 56 experts on diabetes care were invited to fill in a questionnaire. This included a ranking of 18 elements on the organization of diabetes care and 9 on patient education. RESULTS: The response rate was 87.5%. With regard to the organization of care 'active patient participation', 'protocolized care' and 'patient education' were evaluated as the most important. The integration in daily diabetes care was seen as the most important aspect of patient education. Optimal diabetes patient education would include five sessions (range: 1-10) of 1 h (range: 0.25-3) with active follow-up. The most appropriate disciplines for patient education are the diabetes nurse (chosen by 93% of the experts) and the dietician (77%). CONCLUSIONS: Optimal care for diabetes mellitus type 2 consists of structured care with integrated patient education. The majority of the experts indicated that this is not optimally organized within the Netherlands.

Attitude of Health Personnel↗

Indoor fungal exposure.

Fungi affect humans in complex ways and are capable of eliciting a number of disease responses, such as infectious, allergic, and irritant and toxic effects. Fungal exposure is unequivocally associated with exacerbations of asthma, although the role of fungi in causing the disease is yet to be determined. The association between home dampness and respiratory health effects is strong, and fungal exposure is suspected to be associated with this linkage. Fear of toxin exposures has generated debate over the possible toxic health effects of airborne fungi; however, several recent reviews discount the health impacts of mycotoxin through indoor exposures. Nevertheless, fungal contamination of indoor environments is undesirable. Knowledge of sources and characteristics of fungal spore release and dispersal are important for understanding the processes of exposure. Environmental monitoring for fungi and their disease agents are important aspects of exposure assessment, but few guidelines exist for interpreting their health impacts. Much work is needed in isolating, characterizing and standardizing fungal disease agents to properly assess the prevalence of fungal health effects.

Air Pollution, Indoor↗

Compliance with fluvastatin treatment characterization of the noncompliant population within a population of 3845 patients with hyperlipidemia. CREOLE Study Team.

The objectives of the study were to analyze 1) compliance with an HMG-CoA reductase inhibitor, 2) the relationship between treatment compliance and sociodemographic, clinical, and psychological criteria, and 3) the effect of raising patients' awareness through distribution of an information notice. The results analyzed in this article compare the noncompliant and compliant population independently of awareness. This open-label study was conducted in two randomized parallel groups: a control group that received the information normally given by the practitioners, and an awareness group that received specific informational brochures on diet and cardiovascular risk factors and the reasons for the treatment. Male and female patients (n = 3845) aged 18 to 75 years with primary hypercholesterolemia (type IIa and IIb), not taking a cholesterol-lowering drug or for whom an ongoing treatment was poorly tolerated or ineffective, were to be included. Cholesterol levels had to be greater than 250 mg/dL (or 200 mg/dL if previous coronary history) and triglyceride levels less than 350 mg/dL. A total of 2888 subjects (75%) were defined as compliant (taking more than 90% of the prescription) and 957 (25%) noncompliant. Both populations are identical for age, sex ratio, and different risk factors, with the exception of diabetes. The adverse effects in noncompliant subjects were very clearly different, with an overrepresentation of gastrointestinal and neurologic effects and the noncompliant patients more frequently having more than one adverse effect. Noncompliant patients had an identical duration of follow-up, and the number of patients claiming to have a symptom related to hypercholesterolemia, self-evaluation of cardiovascular risk level, and source of knowledge about cholesterol and diet was similar in both groups. In contrast, in the noncompliant group, there were a larger number of symptomatic patients who thought the drug did not improve the symptoms. In practice, these results show that physicians should systematically evaluate compliance by looking for and analyzing adverse effects and by reassuring the patient when these effects are minor or probably unrelated to the treatment. Diabetics and polymedicated patients deserve special attention in this regard.

Adolescent↗

A customisable framework for the assessment of therapies in the solution of therapy decision tasks.

In current medical research, a growing interest can be observed in the definition of a global therapy-evaluation framework which integrates considerations such as patients preferences and quality-of-life results. In this article, we propose the use of the research results in this domain as a source of knowledge in the design of support systems for therapy decision analysis, in particular with a view to application in oncology. We discuss the incorporation of these considerations in the definition of the therapy-assessment methods involved in the solution of a generic therapy decision task, described in the context of AI software development methodologies such as CommonKADS. The goal of the therapy decision task is to identify the ideal therapy, for a given patient, in accordance with a set of objectives of a diverse nature. The assessment methods applied are based either on data obtained from statistics or on the specific idiosyncrasies of each patient, as identified from their responses to a suite of psychological tests. In the analysis of the therapy decision task we emphasise the importance, from a methodological perspective, of using a rigorous approach to the modelling of domain ontologies and domain-specific data. To this aim we make extensive use of the semi-formal object oriented analysis notation UML to describe the domain level.

Artificial Intelligence↗

Pregnant teenagers: antenatal education research.

Current literature studying pregnant teenagers and their antenatal educational needs has concentrated on subjects such as sex education, nutrition and various teaching methods. What many have neglected to discover are the topics of interest for pregnant teenagers, and if peer discussion groups appeal to them. This article will address these two issues and, furthermore, the preferred time and gestation of a Pregnant Teenagers' Program. A study was conducted, at the Gosford and Wyong Antenatal Clinics of the Central Coast Area Health Service, by voluntary questionnaires to 46 pregnant teenagers attending the clinics, to determine the antenatal educational needs of pregnant teenagers, and if their needs differed from adult pregnant women.

Adolescent↗

Adolescent knowledge, values, and coping strategies: implications for health in sub-Saharan Africa.

PURPOSE: The purposes of this study were to investigate the experiences and knowledge of adolescents living in an urban center in Kenya and to understand how the decisions they make affect their physical and psychological health. METHODS: A sample of 216 adolescents was drawn and they met weekly in small groups with trained facilitators for a period of 6 months. A research team monitored the developments of the groups and the topics they discussed. The findings were corroborated by the adolescents. RESULTS: It was found that adolescents were primarily concerned with developing a coherent and consistent set of personal values which would govern their behavior. Unfortunately, they could not always achieve those values and they resorted to dysfunctional coping strategies which were injurious to their health. CONCLUSIONS: The role of the adolescent in developing countries is complex and poorly defined. In a period of unprecedented change, an urgent and comprehensive review is necessary by all sections of society if the health of this group is to improve.

Adaptation, Psychological↗

Partner condom use among adolescent girls with sexually transmitted diseases.

PURPOSE: To explore associations of self-reported condom use with sexual risk knowledge and behaviors, perceptions of peer condom use, and communication with sexual partners about condom use among adolescent girls with sexually transmitted diseases (STDs). METHODS: Adolescent girls with cervicitis or pelvic inflammatory disease (PID) completed a 62-item self-administered questionnaire on sexual risk knowledge and behaviors, condom use, perceptions of peer condom use, and condom use negotiation with partners. Associations with frequency of condom use and condom use at last sexual intercourse were analyzed. RESULTS: A total of 24 girls were enrolled: 13 with cervicitis and 11 with PID; 22 had complete data for analysis. Compared with girls who reported low frequency of condom use, girls who reported condom use all or most of the time were younger (16.7 vs. 19.5 years; p = .008), were less likely to have a prior history of STD (67% vs. 0%; p = .03), and were more likely to think that all or most of their friends use condoms (72% vs. 0%; p = .02). Compared with girls who had not used a condom with last sexual intercourse, girls who had used a condom were younger (16.2 vs. 17.9 years; p = .04), had fewer lifetime partners (2.7 vs. 8.4; p = .03) and had higher mean scores in condom use negotiation (29.1 vs. 24.4; p = .02), and were more likely to think that all or most of their friends used condoms (100% vs. 31%; p = .001). Knowledge about condoms and STD prevention was high (mean 14.3 +/- 2.3 of 16) but was not associated with condom use. CONCLUSIONS: STD interventions for partner condom use among high-risk adolescent girls must recognize the decrease in condom use with increasing age and focus on maintaining safer sex behaviors, building condom use negotiation skills, and promoting the perception of condom use by friends.

Adolescent↗

The influence of ethnicity on use of herbal remedies in elderly Hispanics and non-Hispanic whites.

OBJECTIVE: To compare the use of herbal remedies between elderly, self-identified Hispanics and non-Hispanic whites (NHW). DESIGN: Cross-sectional, interviewer-administered survey. PATIENTS/SETTING: 186 patients, 65 years and older, at a university-based, ambulatory, senior health center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Differences in herbal use patterns between Hispanic and NHW participants. Main outcome measures were participants' use of herbal remedies, types of remedies used, medical reason for use, age, sex, Hispanic or NHW ethnicity, income, and education. RESULTS: Overall, 61% of patients had used an herbal remedy at some time in their lives. A larger proportion of Hispanic subjects used herbal remedies than did NHW subjects (77% versus 47%, respectively). Hispanic subjects preferred to use the raw herb in a tea, whereas NHW subjects preferred processed herbs in a capsule or tablet form. Significantly more Hispanic subjects grew or gathered their own herbs and received their information about herbs from a family member than did NHW subjects. Few subjects in either ethnic group received their information about herbal remedies from an allopathic provider. For both groups, the herbs most often used were yerba buena, manzanilla, poleo, osha, and alhucema. The top perceived medical problems that herbs were used for were health care maintenance, dyspepsia, upper respiratory infection, skin problems, and anxiety/nerves/insomnia. CONCLUSION: Ethnicity was related to the frequency of herbal use, the choice and preferred form of herb, and the source of knowledge of herbal remedies. Hispanic culture may account for the observed differences.

Aged↗

Neoplasia of reptiles with an emphasis on lizards.

Neoplasia is an important form of disease in saurians. According to previous reviews, the organs most commonly affected by neoplastic disease are the hematopoeitic system, the hepatic system, and the skin. However, our own review suggests that tumors of the musculoskeletal system are also prevalent. Neoplasia should be considered as a significant differential diagnosis when presented with a lizard that has nonspecific clinical signs. The previously described diagnostic techniques should be applied to obtain a rapid and accurate definitive diagnosis. As more cases of neoplastic disease in saurians are reported, a comprehensive study of the data, including detailed examination of environmental factors, may bring forth causative agents. According to Withrow, cancer is one of the leading killers of pet animals, and thus has become a real concern for dog and cat owners [67]. Given that most people will either know someone with cancer or experience cancer first hand, the general public is more educated than ever on neoplastic disorders. As veterinarians, it is important to become familiar with the neoplastic diseases in all species, and to be educated in tumor pathophysiology and treatment. The public expects veterinarians to be dependable sources of knowledge and compassion.

Animals↗