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PubMed2003

A practical method for the evaluation of symptom exaggeration in minor head trauma among civil litigants.

Forensic psychiatrists and psychologists are often called on to provide opinions and render testimony in which minor head trauma accompanied by persistent somatic, cognitive, and/or emotional symptoms is alleged. The frequency of persistent symptoms following such minor head injury is generally low. The forensic clinician therefore must differentiate between subtle brain dysfunction, symptom amplification, psychogenic-based causes for the presence of cognitive and other deficits, or frank malingering. The purpose of this article is twofold: first, to review critical issues related to the assessment of malingering and symptom exaggeration in mild head injury cases; and second, to offer a practical model for the assessment of amplified neuropsychological and psychiatric deficits in civil litigants in cases of minor head trauma.

Craniocerebral Trauma↗
PubMed1992

[Medical education reviewed by legal consultation of civil affairs].

I pointed out the following medical problems based on my own research and investigations of civil proceedings relating to accidents. 1. Pay little attention to the circumstances of the accident 2. Too much emphasis on laboratory investigations for medical diagnoses 3. Unsuitable medication or medical examination 4. Money-making medical care and treatment 5. Poor mental care 6. Unsuitable or incorrect descriptions of the medical conditions of the subject 7. Lack of moral sense 8. Lack of ability to guide the co-medical staff Pre and post graduate medical education must be improved and as forensic pathologists we have to participate in finding a solution for these problems. Now is the time to reform the medical system and the cost of medical examination, treatment and consultation.

Accidents, Traffic↗
PubMed1992

Demographic, life style and anthropometric correlates of blood pressure of Nigerian urban civil servants, factory and plantation workers.

Demographic, life style and anthropometric correlates of blood pressure were analysed in 5,200 civil servants, factory and plantation workers living in an urban setting in the South Eastern part of Nigeria. The subjects were 4,382 men (84.2%) and 818 (15.8%) women. The prevalence of hypertension, using the WHO criteria among the workers was 8.1%, and was lower in women than men, 3.5% and 8.9% respectively. Only 19.6% of the hypertensive population knew that they had hypertension, whilst 29.4% of the total population under study gave a positive family history of hypertension. The blood pressure and the prevalence of hypertension rose with age, number of children in the family, salary scale and with the number of cigarettes smoked per day. The prevalence of hypertension was higher in medium and heavy drinkers than the non-drinkers and light drinkers. The prevalence was also higher in medium and heavy smokers. Multiple regression analysis showed a significant positive relation between the systolic blood pressure and sex, age, marital status, number of children in the family, salary scale, tobacco consumption and weight (P less than 001). On the other hand, occupation (P less than 01) educational qualification (P less than 001), support system (P less than 03) and height (P less than 001) had significant negative relationships with systolic blood pressure. There was also a significant positive relation between the diastolic blood pressure and number of children in the family (P less than 002) and salary scale (P less than 001). It is suggested that hypertension screening and treatment should be incorporated in the primary health care programmes of African communities.

Adolescent↗
PubMed2003

Cholera epidemic after increased civil conflict--Monrovia, Liberia, June-September 2003.

Since 1989, civil war in Liberia has resulted in the displacement of hundreds of thousands of persons. In June 2003, as rebel forces approached the capital city of Monrovia (2003 estimated population: one million), an estimated 300,000 internally displaced persons (IDPs) settled in private homes with family members, public buildings, and other sites. Because of fighting during June-July, the normal collection of health data by the Liberian Ministry of Health (MoH) was interrupted. In June, cases of cholera were confirmed by international nongovernment organizations. To estimate the magnitude of the outbreak, in August, the World Health Organization (WHO) conducted a retrospective review of data collected by health organizations during June--August 2003 but not reported to MoH. Additional data were collected from an emergency surveillance system that began operation on August 25. This report summarizes the results of that analysis, which indicated that as of September 22, a cholera epidemic was ongoing in Monrovia. During the week ending October 20, a total of 1,252 cases of suspected cholera were reported (WHO, MoH, unpublished data, 2003). As of November 12, the epidemic was continuing. The epidemic began in June and was associated temporally with increased fighting and the movement of IDPs. Because cholera transmission was probably attributable to an acute shortage of clean water, poor sanitation, and crowded living conditions, international and Liberian organizations attempted to supply IDP settlements with sufficient potable water and began chlorinating wells. To stop cholera transmission and avoid additional illness and death, further preventive measures are needed.

Cholera↗
PubMed2003

"Commissioned by God": Mother Bickerdyke during the Civil War.

Mary Ann Bickerdyke, nurse, herbalist, and humanitarian, stood out as a singular figure during the American Civil War and afterward. She advocated nutrition and herbal medicines at a time when "heroic," if futile, treatments were often the rule. Her compassion toward ill soldiers was legendary and provided her with the nickname "Mother." Nevertheless, she did not hesitate to stand up to the bureaucratic and occasionally incompetent physician administrators who opposed her. Working in an arena typically off limits for women, she exceeded the bounds proscribed for her sex during the 19th century as a naturopathic physician, humanitarian, and social reformer.

Altruism↗
PubMed2003

Civil War Federal Navy physicians.

The Federal Navy's Bureau of Medicine and Surgery experienced a substantial loss of officers during 1861. It responded to the loss and the increased demand for its services by augmenting its regular medical officers with volunteer physicians. The medical corps more than doubled in size between 1861 and 1865 as a result of the recruiting efforts. Navy physicians were involved in blockade duty, anticommerce raider cruises, amphibious assaults, riverine duty, and staffing naval facilities ashore. Their services are virtually unknown despite their involvement in most naval activity during the war. This article illuminates their efforts. It does so by analyzing individual service records and reports compiled in the Official Records of the Union and Confederate Navies during the War of the Rebellion. The Bureau of Medicine and Surgery successfully met the demands made upon it during the American Civil War.

Government Agencies↗
PubMed2003

The incidence of some civilization diseases in families of children with food allergy/intolerance.

PURPOSE: The aim of the study was to evaluate the incidence of chosen civilization diseases in families of children with food allergy/intolerance. We also wanted to indicate the need for developing and implementing activities preventing these diseases among children. MATERIAL AND METHODS: On the basis of information from questionnaires, two groups of children were distinguished: a group of 80 children suffering from food allergy/intolerance on elimination diet (GR1) and a group of 67 healthy children (GR2) on regular diet. In GR1, the elimination diet with soya bean preparations or casein hydrolysates was introduced before the age of 6 months and continued for at least 12 months. A high risk of hypercholesterolemia according to extended American Academy of Pediatrics criteria including hypertension, diabetes and obesity was determined for children in both groups. RESULTS: The research showed that 31.25% of children examined according to AAP criteria and 46.25% according to extended criteria had a positive family history of premature diseases of the circulatory system. The study proved that hypertension was the most frequent cause of morbidity in families of children from a high risk group and it was found in 67.7% of families with children on elimination diet and with a positive family history and in 78.7% of families with children from GR2 with a positive family history. Obesity, coronary heart disease, hypercholesterolemia, atherosclerosis and diabetes were listed consecutively. CONCLUSIONS: Once a positive family history of cardiovascular diseases is discovered, systematic education promoting health in a family and complex evaluation of physical and psychomotor development of the children should follow. Arterial blood pressure and lipid profile in serum ought to be monitored to eliminate risk factors of these diseases for children.

Cardiovascular Diseases↗
PubMed2004

[Hygienic evaluation of electromagnetic situation and vibroacoustic factors at workplaces for radio-technological staff of civil airports].

The authors proved electromagnetic environment for staff servicing radiolocation, navigation and communication systems in civil airports to be very severe: electromagnetic irradiation of broad frequency spectrum, in impulse and continuous generation mode, varying in intensity and time, with low telluric conditions in shielded chambers, with equivalent noise levels more than by 15 dBA exceeding the allowable ones.

Acoustics↗
PubMed2004

[Civil prodedure or penal procedure in the event of medical fault].

The author specifies the rules and the vocabulary of the civil and penal procedures. He points out the characteristics of the medical act and the failures that a medical practitioner can be blamed for. He defines the notions of the duty of best efforts and the duty to achieve a specific result. The role of the expert is touched upon. The article is supplemented by significant case-law decisions and a list of recent textbooks.

Belgium↗
PubMed2004

Medicare and state health care programs; fraud and abuse: OIG civil money penalties under the Medicare prescription drug discount card program. Interim final rule with comment period.

In accordance with section 1860D-31 of the Social Security Act, this rule sets forth the OIG's new authority for imposing civil money penalties (CMPs) against endorsed sponsors under the Medicare prescription drug discount card program that knowingly engage in false or misleading marketing practices; overcharge program enrollees; or misuse transitional assistance funds.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Distribution and optical purity of methamphetamine found in toxic concentration in a civil aviation accident pilot fatality.

Toxicological evaluation of postmortem samples collected from a pilot involved in a unique fatal civil aircraft accident is described in this paper. A one-occupant airplane was substantially damaged upon colliding with terrain in poor visibility. Remains of the pilot were found outside the aircraft. Pathological examination revealed multiple blunt force injuries and vascular congestion. The fluorescence polarization immunoassay disclosed 8.0 microg/mL amphetamines in urine. Gas chromatographic/mass spectrometric analyses determined the presence of methamphetamine (1.13 microg/mL in blood and 59.2 microg/mL in urine) and amphetamine (0.022 microg/mL in blood and 1.50 microg/mL in urine). Methamphetamine was distributed throughout the body, including the brain. The amount of methamphetamine in gastric contents was 575-fold higher than that of amphetamine. The (+)- and (-)-forms of methamphetamine were present in equal proportions in gastric contents. The methamphetamine concentration found in blood was in the range sufficient to produce toxic effects, causing performance impairment.

Accidents, Aviation↗
PubMedDate not supplied

Drug maker to pay $430 million in fines, civil damages.

Pharmaceutical manufacturer Warner-Lambert has agreed to plead guilty and pay more then $430 million to resolve criminal charges and civil liabilities in connection with its Parke-Davis division's illegal and fraudulent promotion of unapproved uses for the drug Neurontin (gabapentin). The drug was approved by the Food and Drug Administration in December 1993 solely for use with other drugs to control seizures in people with epilepsy.

Acetates↗
PubMed2004

[The current jurisdiction of the Federal Administrative Court concerning the public service employer's obligation within the scope of the Public Support Fund for Civil Servants].

Civil servants are entitled to a subsidy for their health insurance expenses provided the medical interventions are basically necessary and the amount of related expenses adequate. The definition of the borderline between accepted and unaccepted expenses for medical treatment is factually based on the criteria of evidence-based medicine. Accordingly, expenses are not refundable if incurred for treatments and medical products whose efficiency is doubtful or which generally lack scientific acceptance, though under narrowly defined conditions, even "outsider methods" might be approved of. Thus, the law governing these subsidies is more closely related to private insurance than to social security law.

Employment↗
PubMed2004

Medicare and state health care programs; fraud and abuse: OIG civil money penalties under the Medicare prescription drug discount card program. Final rule.

In accordance with section 1860D-31 of the Social Security Act, this rule finalizes OIG's new authority for imposing civil money penalties (CMPs) against endorsed sponsors under the Medicare prescription drug discount card program that knowingly engage in false or misleading marketing practices; overcharge program enrollees; or misuse transitional assistance funds.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Making research matter: a civil society perspective on health research.

Complex global public health challenges such as the rapidly widening health inequalities, and unprecedented emergencies such as the pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) demand a reappraisal of existing priorities in health policies, expenditure and research. Research can assist in mounting an effective response, but will require increased emphasis on health determinants at both the national and global levels, as well as health systems research and broad-based and effective public health initiatives. Civil society organizations (CSOs) are already at the forefront of such research. We suggest that there are at least three ways in which the participation of CSOs in research can be increased: namely, influencing commissioning and priority-setting; becoming involved in the review process and in conducting research; and through formal partnerships between communities and universities that link CSOs with academic researchers.

Community Health Planning↗
PubMedDate not supplied

Protection goals for residents in the vicinity of civil airports.

Based on extensive and detailed reviews the present paper suggests evaluation criteria for aircraft noise for the prediction of noise effects and for the protection of residents living in the vicinity of (newly constructed or extended) civil airports. The protection concept provides graded evaluation criteria: Critical loads indicate noise loads that shall be tolerated only exceptionally during a limited time. Protection Guides are central evaluation criteria for taking actions to reduce noise immission. Threshold values inform about measurable physiological and psychological reactions due to noise exposures where long term adverse health effects are not expected. Evaluation criteria are provided for various protection goals, for hearing, communication and sleep, for the avoidance of annoyance and of suspected cardiovascular diseases. As protection of the residents is understood as a dynamic process, these criteria must be repeatedly tested and adapted to new scientific findings.

Aircraft↗
PubMedDate not supplied

Treatment of gunshot wounds to the colon: experience in a rural hospital during the civil war in Somalia.

BACKGROUND: In the last few decades there has been a clear tendency in civilian practice towards primary repair of gunshot wounds to the colon, resulting in a substantial decrease in the number of colostomies performed for this type of injury. METHODS: The series described here comprises 24 patients with gunshot wounds to the colon treated at the hospital of Jowar in the Middle Shebelle region of Somalia between 1999 and 2001. All injuries were caused by war arms firing high-velocity projectiles. RESULTS: In 18 patients surgery consisted of resection and immediate anastomosis, while in the remaining six patients colostomies were performed including five loop colostomies and one terminal colostomy. The sepsis-related mortality was 25% (6/24). CONCLUSION: Our experience had a peculiar setting, namely that of a civil war in a developing country. In this kind of "difficult" situation there probably exists no ideal procedure and the decisions taken at the operating table are influenced by various factors that are often related to subjective assessment.

Adolescent↗
PubMed2005

Midair collisions: limitations of the see-and-avoid concept in civil aviation.

INTRODUCTION: Midair collisions cause loss of life and property and undermine general aviation; they also represent failures of the see-and-avoid concept in air traffic control. This study identifies limitations of the see-and-avoid concept. METHODS: Analysis of National Transportation Safety Board data on 159 U.S. civil aviation midair collisions and limitations of the see-and-avoid concept. RESULTS: On average, there were 15.6 midair collisions annually from 1991 through 2000. At least one aircraft was maneuvering in 88% of collisions, and both in 70%. There were 77% that involved arrival to, departure from, or flight over an airport, with 61% in the traffic pattern. Head-tail collisions were more frequent in the traffic pattern than out (28.3%, 2.8%, p < 0.05). Other horizontal convergence angles were equally frequent in or out of the pattern: head-on (8.3%, 11.0%), obtuse (11.0%, 8.3%), and acute (13.8%, 16.6%). DISCUSSION: Because the relative bearing to each aircraft on an unaccelerated collision course is constant, pilots sometimes cannot see converging aircraft when climbing, descending, or level. Even if a converging aircraft is unobstructed, it appears small, motionless, camouflaged, and inconspicuous until imminent impact. A statistical model reveals that the probabilities of seeing and avoiding a converging 40-ft aircraft, for an optimal observer or theoretical pilot scanning 2/3 or 1/3 of the time, respectively, are less than 0.91, 0.60, 0.30 at 200 kn; 0.49, 0.32, 0.16 at 300 kn; 0.28, 0.18, 0.09 at 400 kn; and 0.15, 0.10, 0.05 at 500 kn. The see-and-avoid concept has striking physical and behavioral limitations.

Accident Prevention↗