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PubMedDate not supplied

Osteochondrosis dissecans.

Osteochondrosis dissecans ia an osteochondrosis limited to the periphery of secondary ossification centers of diarthrodial joints. It is most frequently diagnosed in the second decade of life, and the knee is the most frequently involved joint; other commonly involved joints include the ankle, hip and elbow. Concepts of pathogenesis consist of reaction to mechanical trauma or spontaneous focal avascular osteonecrosis, but the etiology is not known; however, there is a definite correlation between skeletal maturation and outcome. The objective of treatment should be to prevent the formation of a partially detached or free osteochondral fragment. The preferred treatment in younger individuals is primarily immobilization with bivalved casts or splints. Surgery is to be recommended infrequently in the younger age group but with relatively increasing frequency with older individuals. In the older individuals, tomography, arthrography, and arthroscopy are helpful diagnostic aids in determining the appropriate treatment program. The primary objective of treatment in the older patient is preservation of a congruous articular surface.

Adolescent↗
PubMed1995

A retrospective study of eye disease among first grade children in Los Angeles.

BACKGROUND: The prevalence of ocular disease among children in one school district in Los Angeles, California was studied to better understand the types of eye disorders among this population as well as to develop appropriate preventive programs. METHODS: A computer-assisted retrospective analysis of date was performed from charts of 2,204 first grade children examined in the UCLA Mobile Eye Clinic. RESULTS: One or more ocular disorders were observed in 22.3 percent of the subjects. Uncorrected best monocular visual acuity was 20/40 or worse in 3.4 percent of the children. Refractive errors were diagnosed in 15.7 percent of the subjects, astigmatism in 7.6 percent, hyperopia in 6.2 percent, and myopia in 6.0 percent. Color vision deficiencies (red-green) were found in 2.6 percent of boys. The prevalences of heterophorias and heterotropias were 1.2 percent and 1.3 percent, respectively. CONCLUSIONS: The variety of ocular disorders diagnosed in this demographic setting attests to the importance of performing early and effective screening eye examinations for children.

Child↗
PubMed1993

Tobacco training for the dental profession.

Tobacco kills, but dentists can be effective in limiting its victims by providing tobacco cessation counseling and programs in their practices. This article reviews why such programs are appropriate in the dental office, and touches on how to establish one.

Dentist-Patient Relations↗
PubMed1994

After epidemiological research: what next? Community action for health promotion.

The underlying purpose of all epidemiological research is ultimately to use inferences in order to prevent disease and promote health and well-being. Effective skills in translating results into appropriate policy, programs, and interventions are inherently tricky, and often politically controversial. Generally they are not taught to epidemiologists formally, even though they are a traditionally part of public health practice. To move from findings to policy change requires that the informed and committed epidemiologist should known how to: (1) organize affected parties to negotiate successfully with government and industry; (2) activate populations at risk to protect their health (3) communicate responsibly with lay persons about their health risks so as to encourage effective activism; (4) collaborate with other professionals to achieve disease prevention and health promotion goals. The paper presents and discusses four case studies to illustrate these strategies: (1) the grass-roots social action that was the response of the community to the environmental contamination at Love Canal, New York; (2) mobilization of recognized leaders within the gay community to disseminate HIV risk reduction techniques; (3) collaboration with an existing voluntary organization interested in community empowerment through health promotion in a Chicago slum by using existing hospital, emergency room admissions, and local motor vehicle accident data; (4) a self-help group, MADD (mothers against drunk driving) which fought to change public policy to limit and decrease drunk driving. In addition, the importance of multidisciplinary collaboration and responsible communication with the public is emphasized. Factors that limit the ability of the epidemiologist to move into public health action are discussed, including who owns the research findings, what is the degree of scientific uncertainty, and the cost-benefit balance of taking affirmative public action. Putting epidemiological knowledge to good use should be an integral part of an epidemiologist's repertoire.

Community Health Planning↗
PubMed1994

Contemporary management of breast cancer.

The diagnosis and treatment of breast cancer have changed dramatically during the past two decades. The most important risk factor for breast cancer is advancing age; however, 80% of women with breast cancer have none of the currently identified risk factors. It is undeniable that early detection and treatment of breast cancer reduces morbidity and mortality, and mammography screening is the only method available to detect cancer at the earliest stage when it is most likely to be cured. Although a number of organizations have recommended breast conservation therapy (BCT) as the preferred treatment for early stage breast cancer, marked geographic variations in treatment occur. It is suggested that appropriate education programs be developed for physicians and women to increase familiarity with the selection criteria for BCT and to encourage objective discussions of the treatment options during the patient and physician encounter.

Adult↗
PubMed1995

[Guidelines for the dietetic treatment of patients with anorexia nervosa based on an assessment of their nutritional status].

The evaluation of the nutritional status of patients with anorexia nervosa is of great utility when establishing guidelines for specific and appropriate dietary programs to face nutritional deficiencies and thus favoring their recovery. The nutritional status of patients was evaluated by means of anthropometric, biochemical, and dietetic parameters in a group of 78 anorexics who followed a psychiatric and nutritional therapy, 57 in an ambulatory basis and 21 as in-patients. Anthropometric parameters (weight and body mass index) showed a severe depletion of the nutritional status, particularly in in-patients. Only 25% of patients had a body mass index higher than 18 and 5% had values within normal ranges. While biochemical indexes (hemoglobin, hematocrit, red blood cells, mean corpuscular volume, total proteins and vitamins: thiamine, riboflavin, B6, ascorbic acid, alpha-tocopherol, retinol and beta-carotene) were within normal ranges in most cases, there were variable percentages of patients with marginal values and clearly deficient for group B vitamins: thiamine (79 +/- 11 U/l; P25 = 70 U/l), riboflavin (884 +/- 160 U/l; P5 = 640 U/l) and B6 (309 +/- 131 U/l; P25 = 227 U/l). The study of the diet showed a marked lack of energy supply (only 25% of patients had their needs satisfied (P75 = 101%) and minerals (iron, magnesium, and zinc). Intake of proteins and vitamins was, in general, satisfactory. Critical points to be considered in refeeding are energy and mineral deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Classification and surgical treatment of lumbosacral nerve root anomalies].

In this paper 12 cases of lumbosacral nerve-root anomalies proved on operations were reported. Two roots with a common conjoined origin entering the common intervertebral foramen separately were seen in two cases; two roots arising respectively from the lateral and ventral sides of the dural sac at the level of upper margin of the pedicle, in which one ran transversely into the foramen and another obliquely ran downward, in one case; two roots with closely adjacent origins, in which one ran transversely into the foramen at the level of upper margin of the pedicle and another obliquely ran downward, in four cases; a single root with abnormally large whereas the adjacent root with abnormally small, in five cases. We proposed a classification method for the sake of appropriate surgical program, which assorted the anomalies into three types: (I) General volume of nerve roots in the spinal canal or nerve-root canal abnormally increased, either the diameter of a single root increases or two roots entered the common. foramen; (II) The origin and course of two roots were anomalous; (III) Combination of I and II.

Adult↗
PubMed1994

Managing patients with myocardial infarction after hospital discharge.

Long-term management of patients following myocardial infarction requires assessment of both residual ischemia and left ventricular function, since these are the primary factors in determining the patient's prognosis. Most patients with uncomplicated hospital courses should undergo exercise testing and assessment of the ejection fraction. Aspirin and beta-adrenergic receptor blocking agents should be prescribed to most patients, and angiotensin converting enzyme inhibitors and cholesterol-lowering drugs should be administered when indicated. Psychologic issues unique to myocardial infarction must be addressed, and an appropriate exercise program should be prescribed. The goal is to help patients achieve the functional status they had before the infarction.

Activities of Daily Living↗
PubMed1994

Some anthropometric dimensions of male adolescents with idiopathic low back pain.

OBJECTIVE: To determine whether there were anthropometric dimensions associated with low back pain (LBP) in a male adolescent population. DESIGN: Objective measurement of selected anthropometric dimensions by pretested computer assisted goniometer. SETTING: Temporary laboratory space in three government operated secondary schools in a growth corridor of north suburban Melbourne, Australia. SUBJECTS: Males attending secondary (high) school, aged between 12 and 19 yr. Of 64 subjects that were symptomatic for idiopathic (mechanical) LBP, 38 reported pain at the time of measurement. These were matched by decimal age to a control group of 38 asymptomatic subjects with no history of LBP, drawn from the same population. INTERVENTION: None. MAIN FINDINGS: The dimension "upper body segment" was significantly greater in the group with idiopathic LBP, as was the dimension "sitting height." Contrary to previous findings from adult subjects, the dimension "standing height," while greater for the LBP group, was not significantly so. The dependent measurements "pelvic height" and "suprapelvic height" were significantly greater, confirming previous findings from adult subjects. CONCLUSIONS: The presence of these significantly different anthropometric dimensions in an adolescent population suggests that some adult correlates of LBP may have value as predictors of LBP, detectable in adolescence. Longitudinal observation is warranted to determine their validity as such. The early identification of adolescents with these dimensions may allow the development of appropriate screening programs which in turn may lead to the design and introduction of suitable prophylactic interventional programs for persons found to be potentially prone to idiopathic LBP, otherwise known as mechanical LBP, thus reducing the onset of this expensive problem in adulthood.

Adolescent↗
PubMed1994

Haglund's deformity and retrocalcaneal bursitis.

An excessive prominence of the bursal projection in the posterosuperior aspect of the calcaneous constitutes Haglund's deformity. Swelling in this area constitutes Haglund's disease and is associated with retrocalcaneal bursitis. Rigid and prominent heel counters with high heels impinge on the soft tissues overlying the prominence and give rise to symptoms of pain and swelling. Cavo varus deformities exacerbate this problem. The bursal projection can be demonstrated radiologically by a superior calcaneal angle of more than 75 degrees, a combination of calcaneal inclination and a posterior calcaneal angle of more than 90 degrees, and excessive bone above the upper parallel pitch line. Conservative treatment should always be implemented, and only those that have not benefited from such therapy should be considered for surgery. The results of surgery are satisfactory, provided adequate bone has been resected and no damage to local peripheral nerves or the Achilles tendon has been sustained. After a period of immobilization, an appropriate rehabilitation program must complement the treatment to ensure the early return of function to the tendons and surrounding joints.

Achilles Tendon↗
PubMed1993

Snakebites at Maharat Nakhon Ratchasima Regional Hospital.

One hundred and ninety-nine victims of snakebite hospitalized at Maharat Nakhon Ratchasima Hospital between 1898 and 1991 were studied. The male:female ratio was 1.9:1 and their mean age (+/- SD) was 30.0 +/- 18.6 years. The most common of victims were farmers and laborers. Dead snakes were identified as follows: 72 were Trimeresurus sp. (36.2%), 36 were Naja kaouthia (17.6%), 4 were Bungarus fasciatus (2.0%), 1 were Colloselasma rhodostoma (0.5%) and 1 was Vipera russelli (0.5%). No death was noted among the victims bitten by Trimeresurus sp, C. rhodostoma and V. russelli. Fifty-eight victims exhibited complications, constituting 29.1%. Four cases died from the bite of N. kaouthia, 2 from B. fasciatus and 1 from unidentified snake. A total death rate was 3.5% (7 in 199 cases). The mean duration in the hospital for patients bitten by Trimeresurus sp. and N. kaouthia were 2.3 days and 2.0 days, respectively. In order to decrease the morbidity and mortality of snakebite victims in Nakhon Ratchasima Province, prevention and control of this entity should be emphasized in health education of local people, training programs on appropriate management of snakebites for the medical and paramedical personnel working in the remote rural district hospitals and health centers. In addition, antivenoms and other necessary medical supplies should be adequately provided.

Adolescent↗
PubMed1996

[Epidemiology of ectopic pregnancy: incidence and risk factors].

During the past two decades, the incidence of ectopic pregnancy (EP) has doubled or tripled in many parts of the world. In France, EP currently constitutes 2 % of livebirths and 1.6 % of all reported pregnancies. These rates seem presently stable. The main identified risk factors include pelvic inflammatory disease (PID)--in particular that due to Chlamydial infection, previous ectopic pregnancy and cigarette smoking. More than 50 % of EP cases are attributable to infectious factors and cigarette smoking, suggesting dramatic effects on EP rates of appropriate prevention programs. A third risk which could be prevented is induced conception cycles, especially by Clomiphene. Other risk factors are pelvic surgery, previous EP and maternal age (especially over 35 years). Further epidemiologic research is needed to identify new risk factors, to monitor incidence rates and to evaluate the effects of public health policies on EP occurrence. French EP registers will certainly contribute to this research.

Female↗
PubMed1996

St Jude Children's Research Hospital's International Outreach Program.

Over 80% of children with cancer live in developing countries, where access to medical services is limited to varying degrees. In many of these countries, economic conditions and general health care have improved sufficiently to permit the development of more sophisticated medical services. The introduction of pediatric oncology programs becomes appropriate as deaths from malnutrition and infections decrease and cancer emerges as an important cause of childhood mortality. In the absence of such services, the worldwide war against pediatric cancer will ultimately be lost because of the rapidly growing pediatric populations in developing countries that now lack the facilities and expertise to treat childhood malignancies. We believe that the development of pediatric cancer centers in many of these countries is both appropriate and feasible. Partnerships in which established pediatric oncology centers work with the governments and private sectors of developing nations to implement key facilities are an efficient and cost-effective way to introduce such services. The challenges of these outreach efforts are significant -- as are the expected benefits.

Brazil↗
PubMed1996

Community panel discussions: from research to community action.

HYPERTENSION AND CARDIOVASCULAR DISEASE are increasing among minorities. Participants at the workshop on the Epidemiology of Hypertension in Hispanic Americans, Native Americans, and Asian/Pacific Islander Americans voiced a need to intensify a systemic approach for community-based strategies to guide prevention, treatment, and control. To answer this need, a panel addressed recommended community-based strategies from inclusion of community members in the research process to implementation and application of findings for community action. Recommended strategies include encouraging close cooperation and data sharing between investigators and community groups; including differences in culture, heritage, and local influences in hypertension research; training and working with minority researchers and health care professionals; and intensifying comprehensive and culturally appropriate education programs that focus on prevention, treatment, and control of hypertension. This article contains a summary of key areas of emphasis, as well as implementation strategies to decrease hypertension and other cardiovascular diseases in specific ethnic groups.

Cardiovascular Diseases↗
PubMed1997

[The homeless and the health system: profile of the homeless patient].

The homeless population is mobile and does not use ambulatory health care services. Thus the major contact between the homeless and the medical establishment occurs primarily when they are treated for acute symptoms in hospital. We describe the clinical and sociodemographic profile of the homeless who require hospital services. The research population included 50 homeless treated in the emergency room and various departments of our medical center between October 1994 and August 1995. Social workers used a questionnaire relating to clinical, sociodemographic and social factors. Most patients were men, 76% under the age of 50. The most common diagnosis was alcoholism; other diagnoses included back, limb and joint injuries, infections, skin diseases, and general exhaustion. There were subgroups with differing needs within this homeless population for which appropriate rehabilitation programs are proposed.

Adult↗
PubMed1997

PCR-based screening for cystic fibrosis carrier mutations in an ethnically diverse pregnant population.

As the most common lethal autosomal recessive disorder in North America, cystic fibrosis (CF) is an obvious candidate for general population carrier screening. Although the identification of the causative gene has made detection of asymptomatic carriers possible, the extreme heterogeneity of its mutations has limited the sensitivity of the available DNA screening tests and has called into question their utility when they are applied to patients with no family history of the disease. The purpose of this study was to determine the technical feasibility, patient acceptance and understanding, and psychosocial impact of large-scale CF carrier screening in an ethnically diverse pregnant population. A total of 4,739 pregnant women attending prenatal clinics located in both an academic medical center and a large HMO were invited in person to participate. Of this group, 3,543 received CF instruction and assessments of knowledge and mood, and 3,192 underwent DNA testing for the six most common CF mutations, by means of a noninvasive PCR-based reverse-dot-blot method. Overall participation rates (ranging from 53% at the HMO to 77% at the academic center) and consent rates for DNA testing after CF instruction (>98%) exceeded those of most other American studies. The PCR-based screening method worked efficiently on large numbers of samples, and 55 carriers and one at-risk couple were identified. Understanding of residual risk, anxiety levels, and overall satisfaction with the program were acceptable across all ethnic groups. Our strategy of approaching a motivated pregnant population in person with a rapid and noninvasive testing method may provide a practical model for developing a larger CF screening program targeting appropriate high-risk groups at the national level, and may also serve as a paradigm for population-based screening of other genetically heterogeneous disorders in the future.

Academic Medical Centers↗
PubMed1997

Effective breastfeeding support in a general practice.

OBJECTIVE: To determine the effectiveness of a breastfeeding support service attached to a general practice. DESIGN: A lactation consultant (LC) was employed in a general practice in Happy Valley. Adelaide over 12 months to provide an appropriate intervention program of education and support for mothers experiencing problems with breastfeeding. The mothers were asked to evaluate the service via a postal questionnaire. The baseline rates of women in this practice who were solely breastfeeding were determined by a retrospective questionnaire sent to all mothers of the practice whose children were 18 months to 2 1/2 years of age (168 mothers formed this baseline group). There were 119 mothers in the intervention group. RESULTS: There was a high, breastfeeding initiation rate for both baseline (94.6%) and intervention (93.4%) groups. There were significantly higher breastfeeding rates in the intervention group at 24 and 26 weeks (63.3% vs 51.2% at 24 weeks [p = 0.015] and 64.7% vs 50.6% at 26 weeks [p = 0.018]). While there was no significant difference in the total number of breastfeeding problems encountered by either group significantly more mothers from the baseline group suffered from engorgement and/or too much milk. Evaluation of the service indicated a high degree of satisfaction. Over 94% of the mothers found the service friendly, supportive, and useful. CONCLUSIONS: This service provides an effective method for the support and protection of breastfeeding.

Adult↗
PubMed1997

Endovascular surgery: past, present, future.

In the 33 years since Dotter described his innovative treatment of an arterial obstruction using transluminal dilatation, endovascular therapy has developed into an important and necessary part of the treatment of occlusive vascular diseases. Today, three major endovascular therapies: balloon dilatation, intraluminal stenting, and athrectomy have earned full FDA approval and have predictable and acceptable short- and long-term outcomes. These procedures may be used as "stand alone" therapies or in conjunction with standard vascular surgical reconstructions to provide the best outcome for each patient. In general, endovascular treatment can be expected to result in lower morbidity and mortality than traditional vascular surgical interventions. However, the long-term outcome of these therapies is often less durable. Both the standard and endovascular therapies will likely be performed into the 21st century; so an appropriate treatment program specific for an individual patient can be developed. This program should balance risks of treatment with anticipated benefits when considering the expected longevity and comorbid conditions of the patient. A new technology with limited FDA approval is the technique of endovascular grafting. This technology and the development of new treatments to minimize or prevent restenosis should revolutionize the practice of vascular surgery in the future.

Angioplasty↗