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At least 595 records · Page 33Linked to original sources
PubMed1993

[An application of a study of medical history to clinical medicine - for better understanding of medical history and its application to clinical medicine].

A study of medical history aims to correctly understand the progress in basic and clinical medical science and to effectively offer better medical service to our patients. The study of medical history has several important advantages, such as; 1) to understand the present medical science in depth and to shorten the duration of time needed to understand the present medicine, 2) to understand the disadvantages of the present medical sciences realizing that they are not perfect, 3) to correctly understand literature and historical documents on medical science, 4) to make and maintain accurate medical records and documents, 5) to create new concepts and 6) to prevent us from developing a rigid way of thinking. Two cases of the application of medical history to clinical medicine are shown. The first is in regard to perioperative blood transfusion. As it was suggested to me by a report that preoperative blood transfusion caused suppression of immune response in kidney transplantation, I thought a routine use of blood transfusion for surgical patients with malignant tumors would lead to a high postoperative recurrence rate of malignancy. Therefore, such a routine use of blood has been avoided inn our institution for these twenty years. The second case is in regard to excitement during the induction of inhaled anesthetics. At present the excitement is considered to be caused by inhibition of the cerebral cortical function. However, our recent clinical study based on Dr. Maeda's report published in 1935 has revealed that the excitement observed during the induction of inhaled anesthesia is caused mainly by stimulation of the trigeminal nerves. The importance of medical history should be much more stressed for medical training of students and residents as well as physicians. It should be widely and deeply applied to the clinical practice of medicine, though it is not so easy to do this. Otherwise, the study of medical history may be considered as only a hobby for retired physicians.

Clinical Medicine↗
PubMed2001

[Immunisation of fancy chickens against Newcastle disease].

The German Regulation on Fowl plague which is in force since 1994 laid down that any chicken of all races and all hybrids must be vaccinated against Newcastle disease (ND) in a mode that an adequate immunity is achieved. Onset, duration, and resistance to challenge of immunity induced by vaccination is well documented in the scientific literature for hybrid chicken of the layer and meat types. These data prove also innocuity and efficacy of the registered vaccines. In contrast, only a few and incomplete data exist on the development of ND directed immunity in fancy chickens. The present study describes vaccinations of chickens of 14 different hobby breeds with live LaSota vaccine (conjunctival application of 10(6) embryo-infective dose50 per bird) and with an inactivated oil-emulsion vaccine (intramuscular application of 0.5 ml per bird) and subsequent intramuscular challenge infections using the highly virulent NDV strain Herts 33/66. Chickens of all 14 breeds tolerated the application of both vaccines. All fancy chickens reacted with the production of serum antibodies which were measured in the haemagglutination inhibition (HI) and virus neutralisation (VN) tests. According to the scientific literature, maximal antibody levels are reached in hybrid chickens between day 10 and 20 post vaccination. In contrast, in fancy chickens the antibody maxima are delayed to the seventh to eighth week post vaccination. All fancy chickens vaccinated either once with live LaSota virus or with live and inactivated vaccines resisted challenge with the highly virulent Herts 33/66 strain of NDV and did not develop any signs of disease. There are indications for gradual differences in susceptibility of different breeds of fancy chickens. The levels of non-specific neutralisation as measured in the virus neutralisation test differ between breed. Also, the viral content in tissues obtained from non-vaccinated but challenged birds differ markedly. It is concluded from the results of this study that fancy chickens can also successfully protected against Newcastle disease by using live and inactivated vaccines which are licensed for hybrid chickens. However, the optimal time for the detection of maximal antibody levels in fancy chickens is reached seven to eight weeks post vaccination.

Animals↗
PubMed2001

[Lead poisoning in adults. Experience of the Poison Control Center of Marseille from 1993 to 2000].

OBJECTIVE: Report the experience of the Marseille's anti-poison center with lead poisoning adults. PATIENTS AND METHODS: Between 1993 and 2000, 45 adults patients consulted the poison Centre of Marseille for a history of lead exposure (9 women, 36 men, average age 44 YO, between 22 an 76 YO). The lead sources were mostly occupational (welding, heavy metal industries...), but some were environmental (shooting as a hobby, hunting,...). RESULTS: Ninety-one percent of the patients presented with a clinical feature of possible lead intoxication (asthenia, abdominal pain, anaemia, seizures,...). For 22 patients, calcitetracemate provocation test was negative. 6 patients with a positive test refused to be treated. 16 patients with a positive test were treated with chelation therapy (average lead blood level 566 micrograms/l--mini 320 micrograms/l, maxi 943 micrograms/l--and average lead urine elimination 3,011 micrograms/24 H--mini 789 micrograms/24 H, maxi 7,229 micrograms/24 H. 58 cures were done (1 to 12 cures for each patient). The average quantities of lead eliminated in the urine during the chelation therapy was 30,912 micrograms +/- 29,059 micrograms by case. For 12 patients who stopped the lead exposure after the diagnosis of lead poisoning, the chelaion therapy permitted to decrease the lead blood level of 69%. For 4 patients still exposed during the treatment, the lead blood level decrease of 7% only. For the 16 treated patiEnts, a clinical improvement was noted, and no adverse effects of chelation therapy was observed during the 58 cures.

Adult↗
PubMed2001

Risk and protective factors among youth offenders.

This exploratory study examined the risk and protective factors of youth offenders and their relation to recidivism. The sample consisted of 76 male and female juvenile probationers within a large metropolitan area. Archival records on probationers provided data on prior offenses, personal characteristics, familial conditions, drug use, peer selection, school performance, role models, and activities and hobbies. It was found that protective factors, specifically personal characteristics, familial conditions, and peer selection, differentiated nonrepeat offenders and repeat offenders. The present body of findings supports the adaptive model of resiliency and reinforces the importance of enhancing protective factors in youth offenders as a means of deterring delinquent behavior.

Adolescent↗
PubMed2001

[Foot and mouth disease in sheep and goats].

Small ruminants play an important role in the epidemiology and transmission of Foot-and-Mouth Disease (FMD). The main reasons therefore are: FMD is difficult to diagnose as infected sheep not always show typical clinical symptoms or as the cardinal signs mimicked other diseases. Sheep and goats may be carriers. Infected herds which practice transhumance or are nomadic can spread the infection to other herds long before diagnose of the disease is established. Shipping and trade with live sheep and goats is much more common world wide than in other FMD susceptible species. Lack of registration of all sheep and goat herds (especially of small hobby herds) and lack of individual identifications signs (ear tags) may result in incomplete control measurements under FMD conditions. Basing on published experiences with the actual FMD epidemic in the UK and basing on the own experiences with the restrictions to prevent from spreading of the FMD from the UK to Germany suggestions for future disease control are made.

Animals↗
PubMed2002

Wegener's granulomatosis: survey of 701 patients in North America. Changes in outcome in the 1990s.

OBJECTIVE: To study the medical and socioeconomic impact of Wegener's granulomatosis (WG) in a large cohort (n = 701) of patients who are members of the international WG Support Group (WGSG). METHODS: Forty questions designed and validated by one of the authors and reviewed by the medical consultants of the WGSG International were mailed to 1690 patients with WG who are members of the WGSG; 701 (41%) patients returned the questions. Diagnosis of WG was self-reported for purpose of this questionnaire. Study domains included demographic features, education, analysis of categories of medical care providers, organ system involvement, delay in diagnosis, frequency and sites of biopsies to assist in diagnosis, treatment outcome, familial association, disability, and financial effect. We compared some of these features in patients whose diagnosis was made in the 1970s, 1980s, or 1990s. RESULTS: In our cohort WG was slightly more prevalent in women (56%), particularly if the disease started at a younger age (9-40 years). Peak age period at disease onset was 45-65 years. Ninety-eight percent of patients were Caucasian. Diagnosis of WG was usually made by a specialist, and the majority of patients received subsequent care by specialists. During the past decade only 7% of patients received a diagnosis of WG upon their first visit to a physician. A period of 3-12 months passed from onset of features of WG to achieving a diagnosis in the majority of patients. Compared to the period 1970-90, in recent years fewer patients had biopsies performed for diagnostic purposes. This observation correlated with increased use of antineutrophil cytoplasmic antibodies. In the 1990s the most common reported therapy was combination of corticosteroids and cyclophosphamide (73%). Patients also reported initial therapy with methotrexate (11%), trimethoprim-sulfamethoxa-zole (32%), and azathioprine (5%). Patients rarely reported other family members with WG. In none of 12 WG patients who had a twin did the twin have WG. The survey did not identify any specific environmental exposure, occupation, or hobby that was overrepresented among patients. One hundred seventy-nine WG patients reported that their disease had a significant financial impact on their lives. CONCLUSION: Information from this survey of 701 patients is consistent with physician reported data about organ involvement, initial manifestations and therapy, and outcomes in WG. More WG patients in the 1990s were diagnosed after first physician encounter. This survey did not reveal any predisposing or inducing environmental or familial factors, and showed fewer patients become disabled and more were able to work full time.

Adolescent↗
PubMed2002

[The effects of stressors at work and in family life on self-rated health and psychological well-being].

OBJECTIVE: This study examined the effects of stressors at work and in family life on self-rated health and psychological well-being. METHODS: The subjects were civil servants of T City (pop. 210,000) aged 35 years and older. In February 1998, a questionnaire survey was conducted (response rate: 82.6%). The 1,364 responders comprised 971 men, including 143 firefighters, and 393 women. Participants, excluding firefighters, were categorized into two groups according to satisfaction with their job and their family life. In these two groups, the stressors at work and in the home was examined. Job demands-control-support score, type of work, job rank, family control and close friends were examined with the t-test, and sex, hobbies and age examined with the chi 2 test. This was followed by covariance structure analysis of self-rated health and psychological well-being. RESULTS: For the groups dissatisfied with work or family life, the score for jpb demands was higher, and the scores for job control, social support and close friends were lower. The scores for self-rated health and psychological well-being items were also significantly lower. Covariance structure analysis demonstrated that factors at work had stronger effects. Regarding individual factors, job control, satisfaction with their job or family life and close friends had the greatest influence. CONCLUSIONS: Stressors at work and in family life result in lower self-rated health and psychological health. In particular, close friends and factors at work exert strongest effects on personal health. It is thus important for the prevention of stress-related diseases and the development of positive healthy life to reduce the work stressors and develop close friendships.

Adaptation, Psychological↗
PubMed2001

Quality of life of elderly patients undergoing continuous ambulatory peritoneal dialysis.

OBJECTIVE: The aim of the present study was to evaluate the impact of continuous ambulatory peritoneal dialysis (CAPD) on the lifestyle of elderly patients. PATIENTS AND METHODS: Aspects of health-related quality of life (OL) were studied in 48 patients (16 men, 32 women) in end-stage chronic renal failure (ESRF) undergoing CAPD at the Clinic of Nephrology, Clinical Centre of Serbia. The first group comprised 20 adult patients (8 men, 12 women; age range: 35-59 years). The second group consisted of 28 older adult patients (8 men, 20 women; age range: 65-75 years). Mean length of CAPD treatment was 5.2 years in the first group and 3.67 years in the second group. Fifteen QL variables were investigated: marital status, family relationships, working ability, sleep, tiredness, appetite, wound healing, hobby, sports, friendships, sexual activity, mood, travel, self management, and happiness. RESULTS: The results showed that, in the examined groups, marital status and relationships with family members weren't influenced at all by dialysis. In both groups, CAPD had a negative influence on ability to bear cold and to travel, but other life functions were not significantly affected. Elderly patients had a significantly worse appetite (p = 0.03, Fisher test) and mood (p = 0.045, Fisher test) than did younger adults. In other examined variables, no statistically significant differences were found between the groups. CONCLUSIONS: Lack of large, statistically significant differences between the groups suggests that CAPD has an equal influence on quality of life in younger and older adult patients.

Adult↗
PubMed2002

Identifying and managing adverse environmental health effects: 2. Outdoor air pollution.

Air pollution contributes to preventable illness and death. Subgroups of patients who appear to be more sensitive to the effects of air pollution include young children, the elderly and people with existing chronic cardiac and respiratory disease such as chronic obstructive pulmonary disease and asthma. It is unclear whether air pollution contributes to the development of asthma, but it does trigger asthma episodes. Physicians are in a position to identify patients at particular risk of health effects from air pollution exposure and to suggest timely and appropriate actions that these patients can take to protect themselves. A simple tool that uses the CH2OPD2 mnemonic (Community, Home, Hobbies, Occupation, Personal habits, Diet and Drugs) can help physicians take patients' environmental exposure histories to assess those who may be at risk. As public health advocates, physicians contribute to the primary prevention of illness and death related to air pollution in the population. In this article we review the origins of air pollutants, the pathophysiology of health effects, the burden of illness and the clinical implications of smog exposure using the illustrative case of an adolescent patient with asthma.

Adolescent↗
PubMed2002

Identifying and managing adverse environmental health effects: 1. Taking an exposure history.

Public concern and awareness are growing about adverse health effects of exposure to environmental contaminants. Frequently patients present to their physicians with questions or concerns about exposures to such substances as lead, air pollutants and pesticides. Most primary care physicians lack training in and knowledge of the clinical recognition, management and avoidance of such exposures. We have found that it can be helpful to use the CH2OPD2 mnemonic (Community, Home, Hobbies, Occupation, Personal habits, Diet and Drugs) as a tool to identify a patient's history of exposures to potentially toxic environmental contaminants. In this article we discuss why it is important to take a patient's environmental exposure history, when and how to take the history, and how to interpret the findings. Possible routes of exposure and common sources of potentially toxic biological, physical and chemical substances are identified. A case of sick-building syndrome is used to illustrate the use of the mnemonic.

Adult↗
PubMed2002

"Managing the unmanageable" the U.S. Department of Health and Human Services, 1989-1993.

The author served as the 17th U.S. Secretary of Health and Human Services, from March 1, 1989 until January 20, 1993. The department had 250 programs and 38 percent of the expenditures of the federal government ($600.0 billion), the fourth largest budget in the world. The history of the department included the fact that the tenure of previous Secretaries had ranged from only eight months up to 37 months, and had averaged 27.5 months, resulting in the view that the department was unmanageable. The author's tenure as Secretary was 47 months, and, in the author's view, the department was indeed manageable. The United States Department of Health, Education and Welfare (DHEW) was created as a cabinet agency in 1953, during the administration of President Dwight D. Eisenhower. The Department was formed by bringing together the Social Security Administration (founded in 1935), the United States Commissioner of Education, and the United States Public Health Service (founded in 1798) to serve the United States Merchant Marines). This new cabinet department contained the nation's major domestic programs concerned with income security, public health and education. Oveta Culp Hobby of Texas was the first Secretary of the Department. By 1989, the department's programs had increased to more than 250, including Medicare, Medicaid, Headstart, Welfare, and others. During the administration of President Jimmy Carter, the Education programs were separated into a new cabinet agency, the U.S. Department of Education, and the name of the U.S. Department of Health, Education and Welfare became the U.S. Department of Health and Human Services (DHHS).

Administrative Personnel↗
PubMed2002

Identifying and managing adverse environmental health effects: 4. Pesticides.

Pesticide exposure can cause many different health effects, from acute problems such as dermatitis and asthma exacerbation to chronic problems such as chronic obstructive pulmonary disease and cancer. The resulting clinical presentations are undifferentiated, and specific knowledge of the links to environmental exposures is often required for effective diagnosis. In this article we illustrate the use of the CH2OPD2 mnemonic (Community, Home, Hobbies, Occupation, Personal habits, Drugs and Diet), a history-taking tool that assists physicians in quickly identifying possible environmental exposures. We also provide clinical information on the epidemiology, clinical presentations, treatment and prevention of pesticide exposures.

Carbamates↗
PubMed2002

Identifying and managing adverse environmental health effects: 5. Persistent organic pollutants.

Concern and awareness is growing about the health effects of exposures to environmental contaminants, including those found in food. Most primary care physicians lack knowledge and training in the clinical recognition and management of the health effects of environmental exposures. We have found that the use of a simple history-taking tool - the CH2OPD2 mnemonic (Community, Home, Hobbies, Occupation, Personal habits, Diet and Drugs) - can help physicians identify patients at risk of such health effects. We present an illustrative case of a mother who is concerned about eating fish and wild game because her 7-year-old son has been found to have learning difficulties and she is planning another pregnancy. Potential exposures to persistent organic pollutants (POPs) and mercury are considered. The neurodevelopmental effects of POPs on the fetus are reviewed. We provide advice to limit a patient's exposure to these contaminants and discuss the relevance of these exposures to the learning difficulties of the 7-year-old child and to the planning of future pregnancies.

Adult↗
PubMed2002

Factors associated with the development of arm lymphedema following breast cancer treatment: a match pair case-control study.

We examined factors that may influence the development of arm lymphedema following breast cancer treatment including the specific mode of therapy, patient occupation and life style. Medical record data and a questionnaire were used to collect information after surgery concerning such issues as wound seroma, infection, adjuvant treatment, vessel string (phlebitis), body mass index, smoking habits and stress. Occupational workload was assessed after surgery whereas housework, exercise, hobbies and body weight were assessed both before and after surgery. Seventy-one breast cancer treated women with arm lymphedema lasting more than 6 months but less than 2 years were matched to women similarly treated for breast cancer but without arm lymphedema (controls). The matching factors included axillary node status, time after axillary dissection, and age. In the lymphedema group, there was a higher body mass index at time of surgery (p=0.03) as well at time of study (p=0.04). No differences were found in occupational workload (n=38) or housework, but the lymphedema group reduced their spare time activities including exercise after surgery compared with the controls (p<0.01). In conclusion, women treated for breast cancer with axillary node dissection with or without adjuvant radiotherapy could maintain their level of physical activity and occupational workload after treatment without an added risk of developing arm lymphedema. On the other hand, a higher BMI before and after operation increases the lymphedema risk.

Arm↗
PubMed2002

Identifying and managing adverse environmental health effects: 6. Carbon monoxide poisoning.

Carbon monoxide poisoning is an enigmatic illness. The symptoms are often non-specific or masked by an exacerbation of an underlying illness, such as congestive heart failure, that has been triggered by carbon monoxide inhalation. The effects can range from mild, annoying symptoms relieved by removal of the source to severe morbidity with profound central nervous system dysfunction, acute complications and delayed sequelae. Estimates suggest that about one-third of nonfatal cases of carbon monoxide poisoning go undetected and undiagnosed. We present a case of residential carbon monoxide poisoning to illustrate these points and to demonstrate the usefulness of a simple tool based on the CH2OPD2 mnemonic (Community, Home, Hobbies, Occupation, Personal habits, Diet and Drugs) that physicians can use to obtain an environmental exposure history. We outline the clinical management of carbon monoxide poisoning and provide strategies and resources to prevent exposure.

Adolescent↗
PubMed2002

A micro case study of the legal and administrative arrangements for river health in the Kangaroo River (NSW).

Kangaroo Valley is a drinking water supply catchment for Kangaroo Valley village, parts of the Southern Highlands and Sydney. It is also a popular recreation area both for swimming and canoeing. Land use has traditionally been dominated by dairy farming but there has been significant and continuing development of land for hobby farms and rural residential subdivision. Dairy industry restructuring has affected the viability of some farms in the Valley and created additional pressure for subdivision. River health is a function of flows, water quality, riparian vegetation, geomorphology and aquatic habitat and riverine biota. River flows in the Kangaroo River are affected by water extraction and storage for urban water supply and extraction by commercial irrigators and riparian land holders which have a significant impact at low flows. Current water quality often does not meet ANZECC Guidelines for primary contact and recreation and the river is a poor source of raw drinking water. Key sources of contaminants are wastewater runoff from agriculture, and poorly performing on-site sewage management systems. Riparian vegetation, which is critical to the maintenance of in-stream ecosystems suffers from uncontrolled stock access and weed infestation. The management of land use and resulting diffuse pollution sources is critical to the long term health of the river. The Healthy Rivers Commission of New South Wales Independent Inquiry into the Shoalhaven River System Final Report July, 1999 found that the longer term protection of the health of the Kangaroo River is contingent upon achievement of patterns of land use that have regard to land capability and also to the capability of the river to withstand the impacts of inappropriate or poorly managed land uses. This micro case study of Kangaroo Valley examines the complex legal and administrative arrangements with particular reference to the management of diffuse pollution for river health. In the past, diffuse pollution has fallen through the gaps in legislation and its administration. Although water pollution legislation is broad enough to embrace diffuse pollution, in practice the Environment Protection Authority has focused on regulating point sources. Water legislation has traditionally been concerned with issues of water quantity rather than water quality. Legislation which allows agency intervention in relation to land degradation has grown from soil conservation roots, neglecting the flow-on effects upon water quality. Under the land use planning system existing land uses are protected from new regulatory requirements. A number of recent developments in NSW law and its administration have set the scene for addressing this past neglect. Water planning provisions in the Water Management Act 2000 have the potential to enable community based Water Management Committees to move away from a narrow focus on water quantity to the broader issues of river health, including water quality. Improved management of on-site sewage management systems is expected as a result of the Local Government (Approvals) Amendment (Sewage Management Regulation) 1998. A draft Regional Environmental Plan prepared for the Sydney Catchment Authority aims to improve the assessment of new development in terms of its impact on drinking water quality. It also moves away from an exclusive concern with controlling new development towards grappling with existing uses. Proposed amendments to the Environmental Planning and Assessment Act, 1979 as detailed in the White Paper, Plan First (2001) include the integration of imperatives derived from catchment strategies and water management plans into local land use plans.

Animals↗
PubMedDate not supplied

"1370 mothers reported killed during physiological duty. Thousands more seriously injured".

"1370 mothers reported killed during physiological duty. Thousands more seriously injured." That was the startling news headline envisioned by Dr. Mahmoud Fathalla of Egypt in a statement to the first regional congress of the Medical Women's International Association for the Near East and Africa. If there was a global newspaper on reproductive health, it could publish that same headline every day, year after year, Dr Fathalla said. Maternal mortality is more than a health issue, it is a human rights issue, Dr Fathalla told participants at the congress, held 29 November to 3 December last year in Nairobi, Kenya. Malaria kills more than the half-million women who die of maternal causes each year, but to compare maternal mortality with deaths from disease is to miss the point, he said. "Pregnancy is not a disease," Dr. Fathalla told the congress. It is good if people do not get diseases such as tuberculosis or cancer, but if the human race is to survive women must become pregnant. They should not have to pay with their lives, because the knowledge and skills to prevent maternal deaths are attainable if the political will exists." Dr. Fathalla was pessimistic about prospects for attaining the Safe Motherhood goals of cutting maternal mortality by half by the year 2000. Mothers continue to die from pregnancy-related causes because societies make a rational decision not to invest in the lives of women, he said. Women's unpaid work in production and reproduction does not feature in national accounting, Dr. Fathalla pointed out. Women suffer discrimination from the start of their lives in terms of nutrition, access to health care and education. Expectations of women are so low it may even seem rational not to invest resources to prevent maternal mortality. Many of the countries with the highest levels of maternal mortality continue to allocate more of their scarce resources to "men's dangerous hobby, war, euphemistically called defense" than to health and education, he added. It is time to get angry, Dr. Fathalla concluded. He called on congress participants to demand that societies invest in women, not simply because of the benefits to children but because women deserve no less than the best.

Congresses as Topic↗
PubMed2002

Mood disorders. Effective management of major depressive disorder in the geriatric patient.

Major depressive disorder (MDD), commonly called depression, is characterized by a collection of psychologic, somatic, physical, behavioral, and cognitive symptoms that interfere with or prevent the execution of normal daily responsibilities and activities (e.g., work, exercise, hobbies, intellectual pursuits). Older persons with MDD are likely to present with weight loss and suicidal ideation or a preoccupation with death. Also common is irritability, anxiety, a change in functional ability, or some combination of these. Pharmacotherapy is an effective intervention for management of MDD symptoms. It can be used in combination with psychotherapy, or as monotherapy in patients who do not respond to psychotherapy and other nondrug interventions.

Aged↗