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PubMed1993

Indochinese patients in the civil commitment process.

This paper examines in detail the involvement of a group of Indochinese patients in the Oregon Civil Commitment process in the calendar years of 1985 and 1986. The authors found that there was no apparent difference in the rate of commitment as contrasted to the overall commitment rate of the general population. The results also indicated that there was heavy reliance on the Indochinese Psychiatric Program and staff to divert the involuntary Indochinese patients out of the commitment process. Furthermore, comparing the involuntary Indochinese patients to a randomly selected cohort of Indochinese patients hospitalized in the same period revealed no differences in demographic data, diagnosis, and treatment history except that the involuntary group was significantly younger and predominantly male. Finally, the follow-up study of the two cohorts showed high rates of hospitalization, noncompliance, and treatment drop-out.

Adult↗
PubMed1993

[The nutritional status of the child entering the Nuevo Hospital Civil de Guadalajara].

With the purpose to evaluate the nutritional status of children hospitalized in the Nuevo Hospital Civil de Guadalajara, they were included 278 subjects that entered in the infant, preschool, schoolchildren and infectious disease clinical ward of the Division of Pediatrics. There were chosen two subjects every day during one year. It was obtained information about family and sociodemographic background. In addition, there were undertaken anthropometric measurements; weight/age, weight/height and height/age indices were also calculated. It was obtained the parameters of median, percentiles and Z-score. Undernutrition was determined by the Gómez and Waterlow classifications. Is was also compared the reference pattern of Ramos-Galván and National Center for Health Statistics (NCHS). Blood was drawn for total protein and hemoglobin. Mean of height/age was 95.74% (NCHS), weight/age 84.04% and weight/height 89.7%. It was not difference on weight/age between Ramos-Galván and NCHS. Weight/height and height/age had little difference. The median system identified more cases with deficit than Z-score, which seems to be more specific and conservative. There is a high prevalence of acute and chronic malnutrition identified with the median system, and maybe reflects the poor quality of life and major morbidity in this population.

Anthropometry↗
PubMed1995

[Civil rights responsibility of the physician: content and limits].

The article illustrates how court opinion has shaped the malpractice issue for medical doctors during the last 40 years and places this development in the general context of civil liability. Jurisprudence in the higher courts has been generally moderate in its steady interpretation of material and procedural questions to illustrate the issue of contractual liability and negligence for physicians and hospitals and also to secure wide-spread legal precedence. A prediction of the future legal development gives rise, however, to some misgivings. Not only will the issue of negligence without fault be questioned but also that of malpractice. This constitutive element of self-employment must not be weakened in any way. Financial, personal, or equipment deficiencies must not be allowed to become liability risks for medical doctors as a matter of course.

Clinical Competence↗
PubMed1995

Civil commitment viewed from three perspectives: professional, family, and police.

This study was designed to uncover differences in interpretation and implementation of civil commitment laws. Such problems in interpretation may contribute to mentally ill persons remaining untreated and potentially joining the thousands of homeless mentally ill persons in our communities or the incarcerated mentally ill persons in our prisons and jails. The study examines differences in the assessments of the severity of mental illness, and the appropriateness and judged feasibility for commitment in different commitment categories, made by emergency room admitting personnel, police officers, and families of mentally ill persons. The results demonstrate that police are significantly less likely than families or mental health professionals to perceive mental disability or a need for involuntary commitment on any grounds. Professional psychiatric staffs were much more likely than the other two groups to consider commitment in all three cases as legally feasible. Family ratings of appropriateness for commitment based on the presented symptomatology are similar to those of professionals. However, they are significantly less likely than professionals to judge the cases as legally feasible for commitment, and they interpret the laws similarly to the police raters in believing that commitment laws will not allow involuntary hospitalizations. Consequences and implications of these differences are discussed.

Adult↗
PubMedDate not supplied

[Cytology based on the Pap test: a 5-year experience at the Department of Gynecology and Obstetrics of the Iseo Ospedale Civile].

The aim of our study was to examine the results we obtained; at the gynaecology and obstetrics Department of the Civil Hospital in Iseo, in order to judge the course of the cervical lesions during the last 5 years. The place of work was our department and service of colposcopy. The patients taking part in the study are women in most cases resident in the territory of our USSL and including all the different ages. We didn't use any criteria of selection and the women showed themselves spontaneously. The reading of pap-test was made at the only referring centre. The result was very satisfactory and it confirms the tendency to an increase of the dysplasia diagnosed during the early phase of manifestation and a decrease of the infiltrating neoplasia diagnosis. In conclusion, we can say that the pap-test showed itself to be an indispensable method in the early diagnosis of the lesions of the uterine neck. Finally, the early recognition of the dysplasie permitted us to carry out some preventive interventions, which are, therefore, less maimed for woman, as well as the demolition of the management costs of the oncological patient.

Adolescent↗
PubMed1977

[An hypothesis concerning the pathogenetic background of 3 diseases of civilization].

This article presents a theory concerning the pathogenetic background for three diseases of civilization: essential hypertension, stable diabetes and atherosclerosis. Man and many other animals have mobilizing mechanisms for preparation for physical activity, expressed inter alia by an increase in blood pressure, hyperglycaemia and hyperlipidaemia. During physical activity, blood pressure falls almost to the resting level and hyperglycaemia and hyperlipidaemia are reduced parallel with the metabolism of glucose and fats in working muscles. In wealthy countries, this preparation for physical activity, which is dominated by the sympathetic-adrenergic system, comes into action just as frequently as in less wealthy countries -- or possibly even more frequently -- but this is rarely followed by muscular activity. How long is this sympathetic dominance maintained? How high are the blood pressure, hyperglycaemia and hyperlipidaemia? How slowly do these return to normal levels? It appears probable that this may be of fundamental pathogenetic significance in the three abovementioned diseases, the causes of which we have difficulty in finding or agreeing upon. Various prophylactic possibilities are mentioned briefly.

Arteriosclerosis↗
PubMed1997

[Civil and criminal responsibility of epileptics].

Since the new Penal Code has come into force, certain sections have been altered, such as those dealing with exculpatory circumstances, and as specialists treating patients with possible mental changes, we should be aware that section 20 now takes the place of the former section 8. The situation of the epileptic with regard to civil and criminal responsibility, has hardly changed. This is not surprising in view of current clinico-therapeutic knowledge. Epileptic patients are legally able to testify, inherit etc. and also have the obligation to compensate for damage they have caused. An attempt is made to define the immunity from prosecution of epileptics in accordance with non-static criteria, and to use a mixed biological-mental formula, which would make it possible to discover whether there was an alteration or anomaly of mental state at the time of the criminal offence, which would mean that the patient was unable to understand the unlawfulness of his action, or to act in accordance with such understanding. The deed itself is considered, without labelling illnesses or persons, seeking a simple definition of immunity from prosecution. The epileptic is immune from prosecution during a full attack, whilst during the rest of the time each case has to be decided individually. We emphasize the necessity of 'declassifying' epilepsy as a typical endogenous psychosis, which puts these patients into the group of the insane, although this term is no longer included in the new legal code.

Criminal Law↗
PubMedDate not supplied

[Epidemiological characteristics of liver cirrhosis at the Hospital Civil of Guadalajara].

OBJECTIVE: A prospective study of the demographic and epidemiologic characteristics of patients with liver cirrhosis at the Hospital Civil de Guadalajara within a period of one year. MATERIAL AND METHODS: A total of 157 patients (48 women, and 109 men) from the Departments of Internal Medicine, Gastroenterology and Liver Clinic were studied. Diagnosis of liver cirrhosis had been previously established based on clinical, biochemical or histopathological information. Additionally, a questionnaire specialized on liver diseases was applied to all patients. RESULTS: Alcoholism was the main cause for cirrhosis (38% in women and 95% in men) followed by viral etiology. The alcoholic beverages consumed with greater frequency were tequila and 96 degrees G.L. alcohol. Women were in the Child-Pugh's "B" class while men were in class "C". Complications were mostly gastrointestinal bleeding, ascites and hepatic encephalopathy. Differences between sexes were observed for various characteristics. CONCLUSIONS: Alcoholism was by far the most frequent cause of liver cirrhosis. The second cause, in women, was of viral origin (16.7%). A national committee of vigilance of liver diseases is proposed to generate more complete and detailed information on the epidemiology of liver cirrhosis.

Abdominal Pain↗
PubMed1997

The legal implications of preflight medical screening of civil airline passengers.

BACKGROUND: It has been suggested that meticulous preflight medical screening of airline passengers would prevent most in-flight medical emergencies and it has been estimated that medical assistance is sought on around 1 in 50 international flights on wide bodied domestic aircraft. It was considered that the legal implications of such screening needed to be determined. METHODS: A literature review of current legislation, court cases, and legal and medical journals was conducted. RESULTS: It was found that the legal problems with preflight medical screening fell into three areas: discrimination, right to free movement, and guidelines to medical contraindications to flying. It was considered that precluding someone from flying on medical grounds could in certain circumstances be construed as discriminatory or a breach of the basic human right of freedom of movement and, thus, unlawful. Current guidelines on medical contraindications to flying vary and there are presently no internationally agreed or legally enforceable protocols on the subject. CONCLUSIONS: Pre-flight medical screening of civil airline passengers may offer a means of reducing in-flight morbidity, but the complexity of the legal issues involved are such that it is unlikely to be introduced in the near future.

Aerospace Medicine↗
PubMed1998

Civil claims relating to pressure ulcers: a claimants' lawyer's perspective.

This article addresses attorneys' evolving views of civil claims against nursing homes, hospitals, nurses and doctors relating to pressure ulcers. The author describes measures that healthcare professionals may take to avoid becoming subject to claims, such as properly documenting assessments of patient risks and documenting consistent and appropriate care. Several issues of ethical consideration for nurses are presented relating to the role of nurses as patient advocates, including the issue of under what circumstances may or should a nurse recommend that a patient confer with an attorney. The article describes some common misconceptions about nursing and medical malpractice claims, and identifies ways that some proposed tort reforms appear borne of unsubstantiated fears.

Humans↗
PubMed1998

Clinical application of the new civil airman vision standards and certification procedures.

INTRODUCTION: The final rule revising the civil airman medical standards became effective September 16, 1996. The purpose of this study was to review changes in the vision standards and procedures and how they relate to the clinical optometrist. METHODS: Revision of Airman Medical Standards and Certification Procedures and Duration of Medical Certificates; Final Rule, (14 CFR, Parts 61 and 67) and the Guide for Aviation Medical Examiners, published by the Federal Aviation Administration's Office of Aviation Medicine, were reviewed, and those parts pertaining to the clinical optometrist were summarized. DISCUSSION: The uncorrected distance visual acuity standards for first- and second-class airmen have been deleted. New equivalent near-vision standards were established for all classes of airmen. A major change--for pilots > or = 50 years of age--was the addition of an intermediate vision requirement of 20/40 or better at 32 inches for both first- and second-class medical certificate holders. Although the third-class medical certificate is still valid for 24 months after the date of examination for those > or = 40 years of age, the certificate is now valid for 36 months for those < 40 years of age. CONCLUSION: The new vision standards primarily affect the elderly pilot. Ophthalmic considerations in the application of the new vision standards are reviewed.

Adult↗
PubMed1998

"Hot beds of disease": malaria and civilization in nineteenth-century British India.

Malaria control was a relatively low priority for the British in India: despite being the principal cause of sickness and death among the Indian people, malaria affected the colonial economy only indirectly and, unlike epidemics of cholera or plague, presented few challenges to public order. Nevertheless, malaria was an important disease: not only in terms of its effects upon the health and livelihood of the indigenous population, but also in the language and politics of colonial rule. Malaria was a signifier of India's "backwardness" and its prevention was closely associated with the mission to "civilize" and tame the Subcontinent. But the gap between this rhetoric and the reality of colonial policy was unconvincingly wide, and the Government of India's failure to tackle the problem of malaria was increasingly criticised by imperialists and nationalists alike.

History, 19th Century↗
PubMed1998

Pediatric traumatic brain injury and burn patients in the civil justice system: the prevalence and impact of psychiatric symptomatology.

The goal of this research was to conduct an assessment of psychopathology in plaintiffs following pediatric traumatic brain injury (TBI) and burns and its relationship to awards of total compensatory damages. Childhood TBI (n = 43) and burn (n = 51) plaintiffs were ascertained through a survey of the U.S. civil justice system involving a review of judicial opinions and verdict reporters in cases that had resulted in an award of compensatory damages in all states from 1978 to 1988. Narrative summaries, drawn from these sources with supplemental information from counsel of record, where possible, were prepared. Psychiatric and disability ratings were made from the summaries, blind to award data. Outcome measures were the pattern and prevalence of psychiatric disorders and their correlation with the awards. It was found that psychiatric disorders, which were almost exclusively internalizing disorders (e.g., anxiety), were present in approximately 25 percent of the subjects in each group. Psychiatric symptoms were not related to the award amount. Significantly greater awards in the TBI group were accounted for by greater disability measures. Physical disability and total disability (including physical and quality of life limitations) were significantly and independently correlated with the award. It is concluded that the prevalence of psychiatric disorders in childhood TBI and burn plaintiffs is similar to that found in TBI and burn subjects in clinical studies. Distribution of disorders is atypical in that externalizing disorders (e.g., attention deficit/hyperactivity disorder) were not commonly reported for either class of injuries. Awards are strongly correlated with disability variables reflecting mainly the severity of physical injury. Internalizing psychopathology may be underappreciated in decisions involving magnitude of awards following selected childhood injuries.

Adolescent↗
PubMedDate not supplied

[PHOLY: A pilot study of drug utilization in civil hospices in Lyon - methodology and difficulties].

PHOLY is a study of drug Prescription in Hospices civils of LYon by a transverse and descriptive survey. It aims at studying the methodology of such an investigation in a large university medical centre, elaborating a methodology for continuous assessment of prescribing, comparing prescriptions with scientific knowledge and identifying specific therapies. We collected 1525 questionnaires from 4333 hospitalized patients in 11 hospitals (prescriptions and indications). The main difficulties we encountered concerned communications (4 letters), fewer questionnaires collected than expected (1525/3018), many missing data, and the lack of a specific budget, thus allowing only partial data exploitation and control. This study revealed many problems such as relevant information for physicians, training and management of investigators, control, data capture and analysis. However, a prescription study may be possible with limited means.

Drug Utilization Review↗