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PubMed2001

A survey of sports injuries among a convenience sample of Israeli athletes.

BACKGROUND: Israel lacks a systematic surveillance of sports injuries, and knowledge of risk factors and specific patterns of injury is inadequate. In order to promote prevention of sports-related injuries, the magnitude of the problem must first be identified and the incidence and severity of sports injuries described. OBJECTIVE: To conduct a survey on previous sports injuries among a sample of Israeli athletes. METHODS: A convenience sample of Israeli amateur athletes participating in the 1997 15th Maccabiah Games was randomly selected. The study group answered an anonymous self-administered questionnaire that included sociodemographic data, and information regarding their sports activity and sports-related injuries that had occurred during the previous 2 years. RESULTS: The study group, aged 12-73 years (median age 21), comprised 301 consenting athletes in 28 different sports. Of these athletes 56.1% reported having had at least one injury. Most injuries (75.6%) involved the upper and lower extremities, and 37.8% of the injured sportsmen had received medical attention from a physician. Half of the athletes participated in contact sports--both collision and limited impact. This group had a much greater proportion of reported injuries in all age groups. CONCLUSION: Surveillance of sports injuries should be expanded in order to develop appropriate prevention programs in Israel.

Adolescent↗
PubMed2000

School health services after Cedar Rapids Independent School District v. Garret F.

In 1999, the U.S. Supreme Court ruled that "school health services" include nursing services that are required for students needing one-on-one ("private-duty") nursing care to attend school. This ruling settled opposing federal court interpretations of the Individuals with Disabilities Education Act, clarifying the rights of students with complex medical needs and the responsibility of school districts to provide them with an appropriate educational program. In responding to the challenges and opportunities raised by this decision, school nurses must understand the implications for school nursing practice and for school districts, educate their school leaders and communities, and provide leadership for creative and collaborative problem solving.

Child↗
PubMed2002

[Imaging diagnosis and classification of hepatic cystic echinococcosis].

OBJECTIVE: To investigate the imaging characteristics of hepatic cystic echinococcosis in different imaging examinations and to formulate an imaging classification. METHODS: The data of pre-operative imaging examination of 2 039 cases with hepatic cystic echinococcosis, who underwent operation during the period January 1984 to December 2000, by B mode ultrasonograohy (all cases), X-ray computed tomography (909 cases), and magnetic resonance imaging (24 cases) were analyzed, being compared with the pathological findings of the resected specimens. RESULTS: Imaging examinations succeeded to identify not only the location, size, and form of hydatid cyst in liver, but also the typical pathomorphology of complications. The hepatic echinococcosis can be divided into seven imaging-diagnostic patterns: solitary cyst (1 625 cases, 79.70%), multiple cysts (414 cases, 20.30%), primary hydatid cyst with daughter cysts (1 114 cases, 54.63%), calcified cyst (186 cases, 9.12%), consolidated cyst (28 cases, 1.37%), cyst with infection (391 cases, 19.18%), and ruptured cyst (298 cases, 14.62%). CONCLUSION: A new diagnostic system of hepatic echinococcosis has been formulated based on imaging examination and by reference to clinical manifestation. It helps select appropriate operation program.

Adolescent↗
PubMedDate not supplied

High-dose fluoroscopy: the administrator's responsibilities.

During the past 15 years, developments in x-ray technologies have substantially improved the ability of practitioners to treat patients using fluoroscopically guided interventional techniques. Many of these procedures require a greater use of fluoroscopy and serial imaging (cine). This has increased the potential for radiation-induced dermatitis, epilation and severe radiation-induced burns to patients. Radiology administrators must realize that these high-dose procedures increase the risk for radiation injury and radiation-induced cancer in personnel as well as in patients. This article discusses particular clinical cases and describes positive, pro-active steps that practitioners and administrators can take to help prevent such injuries in their facilities. Unfortunately, with the exception of radiologists, a large proportion of physicians who use fluoroscopy have effectively no training or credentials in management of radiation or the biological effects associated with its use. In 1994, an FDA advisory warned that training of physicians for modern-day use of the fluoroscope was for the most part insufficient and needed to be expanded. Many prominent medical organizations such as the American College of Cardiology (14) and the American Heart Association (15) have published strongly worded position papers agreeing that there is an urgent need for such training. The consensus is that "rubber-stamp" privileges (16,17) to perform fluoroscopic procedures should no longer be granted. At present, the JCAHO is considering the implementation of a statement regarding JCAHO standards and privileges for practitioners to use fluoroscopic x-ray equipment. Whether or not the JCAHO becomes involved, it is becoming increasingly clear that all practitioners who use fluoroscopic radiation should be required to complete focused training in radiation physics, radiation biology and radiation safety. Training should include the pertinent aspects of radiation management in the clinical setting so that these physicians will be able to acceptably control risks to patients and personnel. The task of securing these materials and lecturers and documenting everything may fall on the shoulders of the radiology administrator or radiation safety staff. Completion of an approved educational program (with appropriate testing) provides the evidence needed by the facility to approve the practitioner's qualifications. In summary, it will take a concerted effort on the part of professional medical organizations and regulatory agencies to insure that the wealth of preventative information now available is disseminated to and put to use by these physicians who may fail to fully appreciate the potential for imparting serious injury to their patients. Even one radiation injury caused by lack of education is unacceptable.

Burns↗
PubMed2002

Declining hepatitis A seroprevalence among medical students in Bangkok, Thailand, 1981-2001.

The severity of clinical symptoms following hepatitis A virus (HAV) infection is age dependent. Hepatitis A in children is mostly an asymptomatic disease while adolescents and adults usually show symptoms of clinical hepatitis. Improved personal hygiene and environmental sanitation has led to a decline in natural immunity acquired in childhood, creating a population of susceptible adults. In the past decade, the incidence and prevalence of hepatitis A disease in Thailand have decreased significantly. In this study, we used enzyme-linked immunosorbent assay to determine the prevalence of anti-HAV antibodies among medical students at two different time points in 1996 and 2001. We then compared these results with data from previous studies in 1981 and 1992. The seroprevalence was 73.01%, 30.23%, 16.67% and 6.67% in 1981, 1992, 1996 and 2001, respectively. A significant decline has happened over the past two decades (p < 0.001). Considering the decreasing immunity to HAV in the younger generations, more cases of symptomatic HAV infection could be anticipated. Further seroprevalence studies in other adolescence groups from different socioeconomic status are needed to elucidate the current situation of HAV infection in the young generation more comprehensively and to develop an appropriate prevention program.

Adult↗
PubMed1996

Technology to save millions, extends vaccine outreach programs. Vaccine management.

Program for Appropriate Technology in Health (PATH), Seattle, Washington, has collaborated in developing a technology that improves the delivery of vaccines in the developing world. HEATmarker is a vaccine vial label which changes color with exposure to heat over time. This allows health workers to verify--at time of use--that each vial of vaccine is in usable condition and has not lost its potency due to heat exposure. Vaccine vial monitors (VVMs) have recently been mandated on all oral polio vaccine purchased and distributed by UNICEF throughout the world. "Vaccine vial monitors will revolutionize the way vaccines are delivered, enabling them to be administered in remote areas, outside the reach of the traditional 'cold chain' that extends from manufacturer to consumer. As a result, millions more children in remote parts of the world will have access to oral polio and other vaccines," states Peter Evans of the World Health Organization (WHO), Global Programme for Vaccine and Immunization. Evans adds, "WHO expects that $10 million a year will be saved for oral polio vaccine alone." VVMs will enable health workers to use vaccine that would otherwise have been discarded. Until now, health workers disposed of any polio vaccine that may not have been properly refrigerated in transport or that had been opened but not used because they were unable to tell if it was potent. In the future, WHO intends to require VVMs on vaccines for measles, hepatitis B, and other childhood diseases, which will result in millions more lives and dollars being saved.

Americas↗
PubMed1975

The psychologic support of the cancer patient: a medical oncologist's viewpoint.

The cancer patient should not be treated differently from other patients. He has the right to good medical care and, especially, sympathetic and constructive psychologic support during all phases of diagnosis, surgery, radiotherapy, and chemotherapy, independent of disease extent or therapeutic response. After the physician has reevaluated his own concepts about cancer and death, he can effectively begin to treat and support his cancer patients. By understanding the individual psychologic problems of cancer patients and their families, a physician can develop an effective psychologic, as well as antineoplastic, treatment program. The family physician has the central role of introducing the cancer patient to his illness and to his oncologic physicians. The surgeon should discuss preoperatively the nature of a patient's problem and the proposed surgical treatment with its possible alterations of bodily function. Postoperatively, he and the family physician should develop a treatment program after appropriate consultation with oncologic subspecialists. If the radiotherapist is consulted and feels radiation therapy is indicated, he should outline his objectives and the possible side effects of therapy. Likewise, the medical oncologist should discuss the potential benefits and possible side effects of anticancer drugs if he feels they should be administered. No one way of supporting the cancer patient is superior. Each patient and his doctors have to develop individual relationships based on honesty, trust, and close communication. A continued commitment to the care of the patient with nurturing of hope and realistic goals is necessary, even when all antineoplastic treatment plans have failed. A satisfactory adjustment of the patient, his family, and the physician as he approaches death can be a natural and beneficial outgrowth of the doctor-patient relationship. Although much attention has been recently focused on the problems of the terminal patient, it is also important to realize that even cured cancer patients may need active psychologic support long after successful antineoplastic therapy has been terminated.

Attitude to Health↗
PubMedDate not supplied

Risk factors of extubation failure in extremely low birth weight infants: a five year retrospective analysis.

Extubation failure is one of the most serious complications in extremely low birth weight infants (ELBWI) on mechanical ventilation therapy. We performed a 5-year retrospective analysis to realize the status of extubation failure in ELBWI. Extubation failure was defined as requirements of re-intubation within 72 hours after extubation. The extubation failure rate was 21% (29/138). The mean birth body weight was 808.3 +/- 140.4 gm. The mean gestational age was 25.8 +/- 1.2 wks. The incidence of chronic lung disease (CLD) in infants with extubation failure was 100% (29/29). Apnea of prematurity 49% (14/29) and post-extubation atelectasis 39% (11/29) were the most common reasons for reintubation. The major microbiology findings which correlated with nosocomial pneumonia in infants with extubation failure were Acinetobacter baumanni (21%), Klebsiella pneumonia (21%), Pseudomonas aeroginosa (14%), and Methicillin resistant staphylococcus aureus (14%). In conclusion, post-extubation atelectasis and apnea were the most common reasons for reintubation. ELBWI with extubation failure had higher incidences of post-extubation atelectasis, CLD, and nosocomial pneumonia. Further prospective studies are needed in order to clarify the appropriate extubation program for ELBWI and to prevent post-extubation atelectasis and nosocomial pneumonia.

Female↗
PubMed1976

[Tumor inactivation and radiobiology].

In this paper, the inactivation of tumors and the tolerance of irradiated surrounding normal tissues is considered under radiobiological aspects. Surviving euoxic cells may be calculated by means of a simple exponential function being characterized by a reduction constant D0. This constant decreases with increasing single doses. Another exponential function allows the calculation of the probability of tumor destruction from the surviving fraction of tumor cells after irradiation. Examples show the probability curves steeply rising with the total dose, in accordance with former observations of Holthusen (S-curves). From the amount of total dose and the steepnees of the rise the values of radiation sensitivity of the particular cells may be evaluated. If there is a fraction of anoxic tumor cells, it is probable that after every irradiation a part of them is transformed into euoxic cells. In such a case, the recovery curves, depending on the degree of reoxygenation, will shift to larger values of the total doses. A good reoxygenation, therefore, is highly important for the success of the irradiation, it can be realized by appropriate irradiation programs. The regeneration (repopulation) of normal cells is of fundamental importance for the restitution of normal tissues following radiation injury. It is generally assumed that the tolerance dose is reached when the number of surviving normal cells arrives at a lower limit. Cohen's measurements at the skin of patients treated with 200 keV X-rays have been used for the calculation of tolerance doses for Co-60 gamma-rays and fast electrons. The tolerance doses depend on the amount of the single doses and result in calculated values of over 10000 rd with electron irradiation of 500 rd per week. These calculations are confirmed by the findings of Schumacher with electron irradiation.

Cobalt Radioisotopes↗
PubMed2003

[Clinical problems of extended intestinal resections].

UNLABELLED: Extended intestinal resections constitute a primary surgical problem, and in numerous cases there is the necessity of programming an appropriate nutrition, including parenteral nutrition at patient's home. The aim of the work was to examine treatment problems: surgery indications, complications and the after-effects of extended intestinal resections as well as the procedure rules. MATERIALS AND METHODS: The group of 51 patients with extended intestinal resections who were subjected to treatment in the years 1988-2002. The group was comprised of 25 female patients with the average age 64.2 years (34-86) and 26 male patients at the age of 56.3 (21-72). RESULTS: Extended intestinal resections resulted from: cancer--30, ischemia (embolism, thrombosis)--12, injury--3, inflammatory bowel diseases--2, intestinal polyposis--2, diverticulosis with hemorrhages--1, toxic necrosis--1.9 deaths were recorded within the post-operative period: 7 (that is 7 of 12) due to ischemia, 1 due to cancer, 1 due to colon toxicum. The overall mortality rate was 17% (that is 9 deaths of all the 51 patients); the highest rate reached as much as 58.3% in the ischemia cases. The most frequent reason of the deaths following extended intestinal resections performed due to ischemia of intestine was: the impossibility of hemodynamic stabilization--3, the escalation of intestinal ischemia and septic shock--2, simultaneously both causes--2. The average length of time between admittance to hospital and surgical intervention was 5.1 days (0-31); the average length of stay in hospital amounted to 20.8 days (2-102). CONCLUSIONS: Extended intestinal resections were the most frequently performed due to neoplastic or vascular reasons. Such surgical interventions are fraught with a high risk of complications and deaths. Furthermore, the foregoing surgeries demand a very expensive therapeutic procedure including the post-operative parenteral nutrition.

Abdominal Pain↗
PubMed1992

The role of the veterinarian in genetic counseling.

When the veterinarian encounters a disorder with an unknown etiology, the following criteria can identify the potential contribution of the animals genome to the problem: 1. The disorder occurs with higher frequency in a group of related animals than in the general population. 2. A defect involves the same anatomic site in a group of related animals. 3. The disease has a consistent age of onset and clinical course. 4. The disease increases in frequency with inbreeding. 5. The disorder is consistently associated with a specific chromosomal anomaly. 6. The disorder can be traced to an abnormality in a single specific protein molecule. Veterinarians must access the information that knowledgeable breeders gather and channel that information constructively into diagnostic tests, test breedings, and data banks to work toward a common goal--discovery of the genetic basis of disease and development of appropriate breeding programs to minimize or eliminate debilitating genetic problems in dogs.

Animals↗
PubMedDate not supplied

[The ordinal localization of mono-type foot bones].

The osteologic collection of the chair for anthropology, Moscow State University, comprising male (n = 70) and female (n = 14) foot bones from persons aged more than 18-20, was investigated. An appropriate Martin program was fixed to the instep bones (IB) of the proximal and middle toe phalanxes (4 sizes for each bone) with 65 signs being studied in each case. The mathematical data processing was SPSS-aided. Diagnostic models for defining the order IB localization in the proximal and middle phalanxes were elaborated on the basis of discriminative analysis. The classification accuracy is maximal for IB (80-100%) and minimal for the middle phalanxes (26.19-77.38%). The definition of the order localization of phalanxes in toes 2-5 is virtually impossible. The designed method can be used alongside with the routine anatomic-and-morphological findings. The congruence of surfaces in the instep-phalanx and interphalangeal joints must be necessarily checked.

Female↗
PubMed1992

Models for dietary and weight change in African-American women: identifying cultural components.

This paper explores cultural factors that potentially influence the effectiveness of weight-control programs for African-American women and attempts to challenge the perception that such programs operate in a culture-free context. The prevalence of obesity and related chronic conditions is notably higher among African-American than among white women. A larger net weight gain during adulthood among African-American women is associated at least in part with a lesser likelihood of losing weight. Evidence from clinical trials also suggests that African-American women have difficulty in losing weight. Cultural variables are thought to limit the intensity of weight-loss motivations among African-American women, but it is also possible that unrecognized cultural variables within behavioral weight-control programs limit their applicability to persons who do not fit a typical middle-class white American prototype. Many perspectives that differ between African-American and American cultures are directly relevant to the tasks and expectations involved in conventional behavioral therapy. Thus, efforts to make programs culturally appropriate for African-American women may need to go beyond superficial adaptations (eg, logistical accommodations) toward a behavioral analysis of weight control as it is likely to be approached by African-American women within their cultural context.

Adult↗
PubMed2004

Utilization of the emergency department after self-inflicted injury.

OBJECTIVES: To compare emergency department (ED) utilization by individuals who present with self-inflicted injuries with utilization by control populations. Individuals with self-inflicted injuries commonly present to the ED, yet little research has been conducted on this population in this setting. METHODS: Individuals who had an ED presentation in 1995-1996 for a self-inflicted injury were tracked prospectively for three to four years of follow-up. This group was matched by age and gender to two groups: individuals who presented with asthma and individuals who presented with other complaints. Data on return visits to the ED were collected from an administrative database. Groups were compared on rates of return visits. RESULTS: There were 478 individuals randomly selected for each group. Individuals in the self-inflicted injury group had higher rates of return visits to the ED over the follow-up period: 232.7 visits per 100 person-years for the self-inflicted injury group, compared with 117.6 for the asthma group, and 83.0 for the "other" group (p < 0.001). The self-inflicted injury group had higher rates for many types of diagnoses: self-inflicted injuries, mental disorders, substance abuse, unintentional injuries, assault, headache pain, and other complaints (all p < 0.001). Patients with more than three repeat visits per year were more common in the self-inflicted injury group (20.1%) than the asthma or "other" groups (9.2% and 5.6%, respectively). CONCLUSIONS: Individuals who harm themselves are chronic users of the ED. The ED represents an opportune setting from which individuals can be directed to appropriate treatment programs.

Adult↗