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PubMed1991

The paid employment of medical students in 1981 and 1989.

A survey on paid employment of students in four of the six years of the medical course yielded a 95% return rate. Ninety-four percent of students responding to the survey were in receipt of a student allowance. Eighty-six percent were in paid employment during the 1988-89 summer vacation, working on average for a little over nine weeks. One-quarter of the sample worked during the May vacation, averaging seven days. Twenty-two percent had termtime jobs during the winter term and 20% worked the week before the survey, averaging a little over 8.5 hours for the week. The results are compared with results from an identical survey conducted in 1981. Reasons for taking paid employment are discussed in the context of current changes to course fees and national employment patterns.

Education, Medical, Undergraduate↗
PubMed1990

Variation in lengths of training among residents enrolled in pediatrics and internal medicine training programs.

Data were gathered in 1987 from 180 pediatrics and 302 internal medicine residency training programs about (1) the length of vacation provided their residents, (2) time allowed them for absence from work for reasons other than vacation, (3) how many of them during the previous three years had been required to extend their training to make up absences from work, and (4) whether a system was in place to cover their unexpected absences from work. All these variables affect the duration--but not necessarily the quality--of training that residents actually experience. The data show that these variables demonstrated wide ranges that depended on the postgraduate year of training, the discipline, the program size, and the program type (university, university-affiliated, freestanding, or military). The Accreditation Council for Graduate Medical Education, training program directors, and the American Board of Pediatrics and the American Board of Internal Medicine each need to consider these variables in making their respective decisions about accrediting training programs, verifying the clinical competence of trainees, and certifying program graduates.

Accreditation↗
PubMed1987

Rapid release of 42K or 86Rb from two distinct transport sites on the Na,K-pump in the presence of Pi or vanadate.

The rate of 86Rb or 42K release from an occluded form of the phosphorylated Na+ pump has been studied using a rapid filtration apparatus described previously. The rate constant of release is 5-15 s-1, and 42K and 86Rb dissociate at approximately the same rate. Mg2+ is required for deocclusion in the presence of Pi at a site which has the same affinity as the site involved in stabilization of E2(K) with ATP; we propose that Na,K-ATPase has only one site for Mg2+ (apart from Mg2+ complexed with ATP), that the affinity of this site for Mg2+ is increased by Pi binding and decreased by ATP binding, and that Mg2+ is bound and released in the normal transport cycle. In the presence of K+, Cs+, Rb+, or Tl+, the release of two distinct 86Rb ions can be observed, the slow release from one site ("s" site) being blocked by occupancy of the site vacated by the other ("f", fast site). By a sequence of incubations, labeled 86Rb can be placed at either site, and the rate of dissociation monitored individually; in the absence of K+, dissociation from the s site proceeds after a lag in which the f site is vacated. The results are consistent with a "flickering-gate" model of deocclusion to the extracellular pump face, in which the site is exposed to the medium only long enough for a single ion to be released. When deocclusion to the intracellular face is promoted with ATP, ions are released from both sites at the same rate, presumably because the E2----E1 conformational change is rate-limiting. Unlabeled ions co-occluded with 86Rb increase the ATP-stimulated rate of release in the order Rb+ less than Tl+ less than Cs+ less than K+; since the same rank order is observed when dissociation from the s site is monitored in the presence of these ions and MgPi we propose that the latter process proceeds toward the intracellular pump face. 86Rb release from the vanadate-inhibited enzyme has the characteristics of Pi-stimulated release but is approximately 25-fold slower. ATP binds to both the phosphorylated and vanadate-inhibited forms of Na,K-ATPase and increases the rate of deocclusion, apparently to both the intracellular and extracellular faces of the pump.

Adenosine Triphosphate↗
PubMed1989

Communication skills and self-esteem in prevention of destructive behaviors.

This study demonstrates the long-range effectiveness of SAY IT STRAIGHT training as a school-based program for the prevention of destructive behaviors by comparing juvenile police offenders among trained and untrained 9th-12th graders for 1 1/2 years following training. In the 1984-85 school year, 357 of the 740 9th-12th graders in a southwestern town completed SAY IT STRAIGHT training. Participation was voluntary and required parental permission. During a five-month pretraining period which began with the first day of school, the number of juvenile police offenders was not significantly different among students who would eventually be trained or not be trained. During the following 7 months including summer vacation, there were significantly fewer offenders among the trained students. The following school year and summer vacation there were again significantly fewer offenders among the trained students. During the whole 1 1/2-year study, the untrained students had about 4.5 times as many criminal offenses as the trained students and their offenses were more severe. Finally, 9th, 10th, and 12th graders as well as 11th-grade females who had been trained showed a significant shift toward behavioral intentions reflecting a greater willingness to implement their constructive decisions and feel comfortable doing so. This study extends the applicability of SAY IT STRAIGHT training which previously has been reported to significantly reduce alcohol/drug-related school suspensions among 6th-8th graders.

Adolescent↗
PubMed1979

Oral surgeons in geographic regions and selected metropolitan areas.

Region of practice location and size of the metropolitan area where a practice is located have been considered important manpower variables. This report of The Manpower Survey of Oral Surgery in 1974 described the relationship of these two variables to various other characteristics of the practice of oral surgery. Geographic region of the respondents and population of the practice location appeared to influence each other to some extent. There was a small but significant relationship between geographic region and age for 2,251 oral surgeons as well as for the 1,584 in full-time private practice. A similar relationship was observed between population of trade area and age. In each situation, the relationship was not consistent enough to describe a definite trend in the relationship. Both geographic region and population of trade area were associated to a small extent with variations in the professional income of oral surgeons. In New England oral surgeons seemed to earn less than expected whereas in the East North Central states they earned more than expected. There was a significant relationship between geographic region, population of trade area, and type of practice. In the eastern part of the United States, there was a tendency for fewer oral surgeons than statistically expected to establish a solo practice. There was some relationship between geographic region and hours devoted to practice for all oral surgeons as well as for those in full-time private practice. Three regions, West North Central, West South Central, and South Atlantic, had significantly more oral surgeons than statistically expected working more than 50 hours/week, whereas three other regions, East North Central, Mountain, and Pacific, had significantly fewer than statistically expected working more than 50 hours/week. In most areas except New England and the West North Central states, geographic region had no association with the average amount of inpatient or outpatient services the respondents provided. Geographic region appeared to influence the average number of surgical procedures performed. It also had some relationship to the incorporation of dental practice and the distribution of dental staff at the principle hospital used by the respondents. According to the 1974 estimated population for calculating the expected frequencies, there were more active members than expected in the American Society of Oral Surgeons in the New England, Middle Atlantic, and Pacific states and fewer than expected in the West North Central, East South Central, and Mountain states. More respondents than expected on the west coast took two weeks or less of vacation whereas more respondents than statistically expected on the east coast took more than three weeks of vacation.

Adult↗
PubMed1982

Absence of respiratory effects in subjects exposed to low concentrations of TDI and MDI.

One hundred seven subjects from a polyurethane plastic manufacturing plant have been followed over a five-year period with measurements of forced expiratory volume in 1 s (FEV1), and questionnaires on respiratory symptoms and smoking habits. Environmental concentrations of toluene diisocyanate and diphenyl methyl diisocyanate were extensively monitored to provide accurate estimates of the upper-limits of exposure of the subjects. Current mean levels of FEV1 in this population were higher than those predicted for healthy subjects. The five-year change in FEV1 did not exceed that expected from aging. No acute change in FEV1 could be demonstrated over the course of a Monday either before or after a two-week vacation. No improvement in ventilatory function was observed over the vacation period. The presence of cough or sputum was related to smoking but was not related to isocyanate exposure. The results indicate that exposure of workers to extremely low levels of isocyanates (time-weighted average concentrations of the order of 0.001 parts per million [ppm]) is not associated with chronic respiratory symptoms or effects on ventilatory capacity. The results suggest that isocyanates can be controlled to the point of eliminating effects as measured by these techniques.

Air Pollutants↗
PubMedDate not supplied

Infectious disease in a total institution: a study of the influenza epidemic of 1978 on a college campus.

The influenza epidemic of 1978 was studied on a college campus, since a college is a type of "total institution" in which work, residence, and recreation are all concentrated in one organization with clearly delineated social boundaries and a unique social structure, A survey of a sample of 418 persons (378 students, 40 faculty members) revealed that more than 48 percent of the students contracted influenza and that the intersemester vacation was a social factor that may have aided in the disease's penetration of the institution's boundaries. The vacation exposed the students to the distase, and the resumption of classes allowed influenza to spread rapidly in the student population, which was concentrated within the boundaries of the educational institution. The faculty exhibited relative immunity to the disease compared with the students, having only a 5 percent attack rate. There were no significant differences in the incidence or duration of illness among the students by sex, year in school, residence area, floor of residence, fraternity or sorority membership, or participation in fraternity or sorority recruitment activities.

Adult↗
PubMed1980

Psychosocial support of residents in family practice programs.

Family practice residency programs (N = 347) were surveyed to examine the frequency of 11 kinds of psychosocial support available to residents through their programs. Family practice programs offer a considerable number of support elements to residents, with programs showing much homogeneity in the kinds of support offered. The size of a program does influence the kinds of support available, with small programs less likely than medium or large programs to offer the formal kinds of support examined in this study. Four patterns of support emerge from the data, each reflecting a specific orientation: (1) the psychological orientation, (2) the "bare bones" of support, (3) the support group orientation, and (4) the family orientation. In general, the kinds of support that address the residents' family needs are least likely to be available. Because time away from work helps to relieve the pressures of residency training, length of vacation and frequency of night call were also examined. On the average, first year residents cover night call every 3.64 nights and have 2.4 weeks of vacation.

Counseling↗
PubMed1996

Can bifocals slow myopia progression?

BACKGROUND: Retrospective studies have suggested that in children with near point esophoria, bifocals can slow myopia progression by about 50 percent. A prospective study was conducted to test this hypothesis. METHODS: Thirty-two children, all with near point esophoria, were randomly divided into either correction with single-vision or with bifocal lenses containing a +1.25 D and. Axial length and refraction were measured under cycloplegia every 6 months for 18 months. Twenty-eight children completed the study. RESULTS: Myopia progressed at an equal rate in both groups for the first 12 months. Progression was much faster during the first 6 months, which was during the school year, than during the second 6 months, which included all of the summer vacation (0.64 D/yr vs 0.29 D/yr). During the last 6 months, myopia progressed rapidly for children in single-vision lenses (0.80 D/yr) but slowly for those in bifocals (0.37 D/yr). A repeated-measure analysis of variance showed that season of the year had a significant effect on myopia progression (p > 0.002) and that the effect differed for the two treatment groups (p > 0.043). Over the whole 18-month study, myopia progressed at rate of 0.57 D/yr for those in single-vision lenses and 0.39 D/yr in those in bifocals (p = 0.26). CONCLUSIONS: Bifocals seemed to slow myopia progression in these children with near-point esophoria, although a longer-term study with more subjects is needed to confirm this finding. Myopia progressed more rapidly during the school year than during summer vacation.

Adolescent↗
PubMed1998

A technique to take leave into account in shift-rota design.

Sick leave, vacations, and the like lead to substantial leave factors. Rota design techniques for covering leave are not always feasible. A small company was helped to develop a new rota. The main requirements were an ergonomically better rota, less overtime caused by leave, and a rota that lets employees take their vacation during the summer. The internal evaluation was unanimously positive after 1 year. A prospective leave coverage was used, with different workhours during summer and spring and with a mixture of shift work and flexible day work. Later the rota was further refined, and broader qualifications of the workers made a much simpler rota possible. The experiences of this study indicate that problems with leave can be reduced if expected variations in leave are considered in the rota design by including variations in workhours. A further promising strategy is to mix shift work with other types of work when time is not a critical factor.

Austria↗
PubMed2005

[Sun exposure behaviors and knowledge among Chileans].

BACKGROUND: Ultraviolet light exposure has a pathogenic effect on the development of skin cancer, whose prevalence increases worldwide. In Chile and the rest of the world, preventive educational campaigns are carried out to change high risk sun exposure behaviors. AIM: To study the behavior of the Chilean population towards skin cancer prevention and to identify erroneous preventive practices and concepts. MATERIAL AND METHODS: A survey containing 17 questions about sun exposure behaviors, photoprotective measures and knowledge about ultraviolet radiation and skin cancer was used. It was applied during January and February 2004, to 1,143 subjects (mean age 30 years, 409 males), taking vacations in beach resorts in Chile. RESULTS: The hours of higher sun exposure ranged from 12 AM to 4 PM. Thirty seven percent of subjects were exposed more than 2 hours during this high risk lapse. Women and subjects aged less than 25 years were those with the riskiest behaviors. Fifty four percent used some type of photoprotection and 50% used ocular protection. Seventy percent used creams with sun screen and 74% used a sun protection factor higher than 15. Seventy percent applied the sun screen as recommended. Thirty eight percent had at least one sun burn in the last two years. More than 90% of subjects were aware of the relationship between sun exposure and skin cancer but 60% did not know the hours of higher ultraviolet radiation. The information about sun exposure was obtained from television in 57% of surveyed individuals. CONCLUSIONS: More educational campaigns about the risk of sun exposure are needed to reduce risky behaviors in the Chilean population.

Adolescent↗
PubMed2006

Effect of neonatal phototherapy on melanocytic nevus count in children.

BACKGROUND: Melanocytic nevus is the strongest risk factor for the development of cutaneous melanoma. Fair skin and exposure to UV light, especially in childhood, are correlated with the development of childhood nevi. OBJECTIVE: To assess the role of blue light neonatal phototherapy used to treat hyperbilirubinemia in nevus acquisition in childhood. DESIGN: Case-control prospective study. SETTING: University hospital. PARTICIPANTS: Fifty-eight children were included in this study. Selection criteria included the following: age, 8 to 9 years; and skin type, less than IV by Fitzpatrick classification (ie, brown, always tans, rarely burns). The case group consisted of 18 children exposed to neonatal phototherapy (mostly intensive phototherapy) retrospectively found by review of consecutive neonatal medical records at Saint-Antoine Hospital, Paris, France. The control group was composed of 40 nonexposed children consecutively recruited from a public school in the same geographic area. MAIN OUTCOME MEASURES: Total body nevus count in children, phenotypic characteristics, solar exposure, and demographic data were assessed by the same dermatologist. RESULTS: A comparison of both groups showed that the number of nevi larger than 2 mm was significantly higher in the exposed group. The mean (SD) nevus count was 3.5 (3.05; median, 3.0) per child in the exposed group, compared with 1.45 (1.99; median, 1.0) per child in the nonexposed group (P(mean) = .02 and P(median) = .01). Multivariate analysis confirmed these results, with a statistically significant correlation with nevus count, especially with nevi 2 to 5 mm in greatest diameter. The association between neonatal phototherapy and nevus count was not significant for nevi smaller than 2 mm or larger than 5 mm. Solar exposure, especially during vacations, was strongly associated with total nevus count and all nevus sizes (2-5 mm, <2 mm, and >5 mm). At univariate analysis, hair color was significantly associated with nevus size smaller than 2 mm (P(mean) = .03). CONCLUSIONS: Intensive neonatal phototherapy is a strong risk factor for nevus development in childhood. While childhood development of nevi is correlated with fair skin and solar light exposure, and having many nevi is a recognized risk factor in persons with melanoma, we must be careful not to equate childhood nevi development in response to neonatal phototherapy with an individual's risk of developing melanoma. The treatment of hyperbilirubinemia remains neonatal phototherapy. Exposed children should undergo dermatologic preventive measures and surveillance for the development of melanoma.

Age Factors↗
PubMed1989

Frontal lobe syndrome in a patient with bilateral globus pallidus lesions.

This article describes a patient who experienced the rapid onset of an irreversible behavioral change while vacationing in La Paz, Bolivia (altitude, 4070 m). The only lesions demonstrated on a magnetic resonance imaging scan were bilateral hemorrhages in the globus pallidus. The behavior change was characterized by apathy and lack of motivation, features commonly associated with bilateral frontal lobe disease. This case is a further demonstration of how subcortical lesions can produce behavioral syndromes that are clinically indistinguishable from classic cortical syndromes. It is cases such as this that show how a strict localizationist concept of behavioral function is too restrictive and how it is necessary to consider a wide network of neuronal interconnections when explaining the mechanism of a dissolution of complex higher functions.

Behavior↗
PubMed2002

Medical hypothesis: why secondary progressive multiple sclerosis is a relentlessly progressive illness.

Secondary progressive multiple sclerosis is a relentlessly progressive, usually ascending, disease process. Once secondary progression begins, regardless of how long the disease was present before secondary progression began, patients appear to progress at a uniform rate. Recent studies show that it responds poorly to medications effective in relapsing remitting disease, although these drugs decrease relapses and have a substantial effect on lesions seen on magnetic resonance imaging. Disruption of axonal transport is known to occur in demyelinated fibers. Synapses, vacated when axons are destroyed, cause sprouting in surviving terminal axons, resulting in metabolic overload in the terminal axons. This noninflammatory process would not be expected to be altered by current disease-altering therapies.

Anti-Inflammatory Agents↗
PubMed1999

Working parents: what factors are involved in their ability to take time off from work when their children are sick?

BACKGROUND: A series of studies has demonstrated that sick children fare better when their parents are present. OBJECTIVE: To examine working conditions that determine whether parents can spend time with and become involved in the care of their children when they are sick. DESIGN: Survey with a multivariate analysis of factors influencing parental care of sick children. PARTICIPANTS: Mixed-income urban working parents aged 26 to 29 years participating in the Baltimore Parenthood Study. RESULTS: Only 42% of working parents in our sample cared for their young children when they became sick. A multivariate logistic regression analysis was conducted to predict which parents stayed at home when their children were sick. Those parents who had either paid sick or vacation leave were 5.2 times as likely to care for their children themselves when they were sick. Of parents with less than a high school education, 17% received paid leave, compared with 57% of parents with a general equivalency diploma, 76% of parents with a high school diploma, and 92% of parents with more than a high school education (P<.001). CONCLUSIONS: The finding that many parents were unable to care for their sick children themselves is important for pediatric care. While low-income children are more likely to face marked health problems and to be in need of parental care, they are more likely to live in households in which parents lack paid leave and cannot afford to take unpaid leave.

Adult↗
PubMed2000

Pulmonary hemorrhage in an infant following 2 weeks of fungal exposure.

BACKGROUND: Exposure to indoor fungus growth and tobacco smoke has been epidemiologically linked to unexplained pulmonary hemorrhage in infants. OBJECTIVE: To describe the 40-day-old male infant who had been exposed to fungi for a discrete 2-week period followed by acute exposure to environmental tobacco smoke prior to development of a life-threatening pulmonary hemorrhage. PATIENT AND METHODS: History and clinical evaluation of the infant immediately followed the pulmonary hemorrhage. Air and surface sampling for isolation and identification of fungal growth in the dwelling where the infant resided before the acute hemorrhage was accomplished when the homeowner returned from vacation 4 months after the clinical event. RESULTS: Two fungi associated with mycotoxin production were cultured from surface samples collected in the residence: Penicillium (possibly Penicillium purpurogenum) and a Trichoderma species. Stachybotrys atra was not isolated from air or surface samples. Environmental tobacco smoke exposure occurred over a discrete several-hour period prior to onset of the acute pulmonary hemorrhage. CONCLUSIONS: Avoidance of unnecessary exposure of infants to fungus growth in water-damaged environments or exposure to tobacco smoke is prudent. Further investigation into the toxic effects of indoor fungi as causes of infantile pulmonary hemorrhage is warranted.

Air Pollution, Indoor↗
PubMed1981

Effect on growth in pemoline-treated children with attention deficit disorder.

The growth of 22 children with attention deficit disorder (ADD) was monitored longitudinally for up to four years. Each child received at least one year of continuous, successful pemoline (Cylert) therapy, after which drug "vacations" were allowed. The effective dosage of pemoline ranged from 56 to 150 mg/day during the first year of treatment. Stature and weight measurements at six-month intervals were matched to those of paired "normal" children from the Fels Longitudinal Study. Significant deficits were observed for mean weight change at six and 12 months after baseline, and for mean stature change at 12 and 18 months after baseline. However, all subsequent six-month results up to four years did not differ significantly between the two groups. These results show a temporary retardation in the rate of growth in weight and stature with later catch-up growth in children treated wih pemoline.

Adolescent↗
PubMed1975

Natural history of male psychological health. III. Empirical dimensions of mental health.

In a nonpatient polulation, the concept of mental health was operationally defined both in terms of behavior and of abstract psychological functioning. Ninety-five college sophomores, selected for psychological health, were prospectively followed up for 30 years. They were assessed by independent raters on a scale reflecting objectively defined healthy adult adjustment; on a scale of clinically defined psychiatric illness; and on a scale of maturity of ego defenses. These three scales were highly correlated. It seemed likely that relatively objective items like length of vacation, divorce, heavy use of mood-altering drugs, career dissatisfaction, and visits to medical physicians can--as a cluster--statistically identify the abstract concept of mental health.

Adaptation, Psychological↗