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At least 991 records · Page 55Linked to original sources
PubMed1991

An adapted language training strategy in the treatment of an electively mute male child.

The present study investigated the usefulness of an Adapted Language Training Program in the treatment of an electively mute seven-year-old male. Training utilized a multiple baseline across behaviors single subject design. Four phases of treatment focused on non-verbal attending, verbal imitative responding, and functional language responding. Systematic attempts at promoting generalization of verbal responses across situations and persons were employed throughout the language program. A 90% appropriate response criterion was reached for all measures. Non-verbal attending and imitative verbal responding remained above criterion at the termination of treatment, but functional language responding regressed to below criterion. Generalization of verbal responses was noted outside of the training sessions.

Attention↗
PubMed1993

Hemispatial factors in mirror writing.

The effect of the hemispace in which writing was performed was assessed in two left hemisphere stroke patients who demonstrated left-handed mirror writing. Both patients produced significantly more mirrored words when writing in right, as compared to left (body) hemispace. We suggest that writing in the right hemispace activates the left hemisphere. Further, we propose that mirror writing in the right hemispace is attributable to activation of the damaged left hemisphere spatial system, which fails to assist in the translation of right hand motor programs into those appropriate to the left hand. Writing in left hemispace, in contrast, activates the intact right hemisphere based spatial system which guides the execution or monitoring of motor productions in left hemispace. The result is writing which remains directionally correct when the left hand is used in left hemispace.

Agraphia↗
PubMed1995

Central neural organization and control of sympathetic nervous system in mammals.

The past decade has witnessed rapid progress in defining neural circuits and mechanisms in the brain, responsible for regulation of the sympathetic nerve activity and cardiovascular functions. Several groups of cardiovascular neurons in the brainstem form the fundamental neural circuits, through which reflexly and centrally initiated sympathetic responses are processed. Their interplay determines the levels of sympathetic nerve activity and vascular tone. Substantial evidence indicates that a small population of reticulospinal vasomotor neurons in the rostroventrolateral reticular nucleus of the medulla oblongata play critical and integrative roles by: 1) providing, largely by their intrinsic pacemaker activity, tonic sympathoexcitation, thus maintaining normal blood pressure and organ blood flows, 2) mediating a variety of circulatory reflexes and centrally initiated sympathetic responses thereby helping to match organ blood flow to metabolic demands, and 3) acting as intrinsic oxygen detectors which orchestrate appropriate autonomic response programs to protect the integrity of brain in response to acute hypoxia-ischemia. Elaboration of the neural mechanisms and cellular and molecular properties of these vasomotor neurons related to dynamic regulation of the cardiovascular system in normal and disease states will be of relevance to a full appreciation of their role in adaptation of the organism to its internal and external environments and to the development of strategies to fight against neurogenic cardiovascular diseases and to restore normal functions.

Animals↗
PubMed2006

Prevalence of oral cancer and potentially malignant lesions among shammah users in Yemen.

The purpose of this study was to assess the prevalence of oral precancerous lesions and squamous cell carcinoma (OSCC) in Yemeni users of shammah, a traditional smokeless tobacco habit known in the Arabian Peninsula. The study group comprised 199 male and one female shammah users who were interviewed via a standardised questionnaire and clinically examined in 48 Yemeni villages and cities. Cases with oral leukoplakia (OL) or mucosal burns (MB) were compared with users without any lesion. MB were detected in 31%, of which 46.8% were located on the tongue or floor of the mouth, and OL in 27%, of which 59.2% were located in the same region. In addition, two cases (1%) of apparent OSCC were identified. Statistically significant increased OR (95% CI) of OL were (a) 6.91 (2.66-17.95) for an average duration of the respective shammah application >5min.; (b) 4.90 (1.99-12.08) for a daily frequency of those applications >10; and (c) 4.22 (1.43-12.43) for a daily duration >6h of chewing qat, also a traditional habit in Yemen. Likewise, decreased OR were (a) 0.39 (0.18-0.85) for rinsing the mouth after the shammah application; (b) 0.36 (0.17-0.78) for successful attempts to stop the use in the past; and (c) 0.26 (0.09-0.72) for existing knowledge about the carcinogenicity of shammah that was present in only 19% overall. In conclusion, evidence was shown for a significant association between the prevalence of OL and the daily duration of shammah application in a dose-dependent manner. An appropriate public health program might help to reduce this potential OSCC burden in shammah users.

Adolescent↗
PubMed2006

The role of culture in breast health practices among Chinese-Australian women.

OBJECTIVE: Exploring how cultural meanings of the breast impact on perceived images of breast cancer and breast health practices. METHODS: In-depth interviews were conducted with 20 Chinese-Australian women in their native language (Cantonese). RESULTS: The findings revealed that the meanings of the breast are constructed within the women's social and cultural context where breasts are associated with sex; and talking about, being concerned with or expressing curiosity about breasts is considered inappropriate. These views have a significant impact on (1) the way the informants viewed breast cancer; (2) perceptions of breast health practices; and (3) the explanations of breast cancer and associated risk perception. CONCLUSION: Understanding the nature of culturally-based barriers to utilization of breast cancer screening is the first step to discovering solutions for making screening tests more acceptable to women from other cultures. PRACTICE IMPLICATIONS: This study provides insight about obstacles for breast health promotion practices and for developing culturally appropriate health education programs and counselling strategies.

Aged↗
PubMed2004

Field evaluation of vaccine safety.

Surveillance of adverse events in the field represents an essential part of vaccination strategies. Safety studies conducted before vaccine licensure have often not enough power to detect rare or long-term adverse events. Furthermore, adverse events may be caused by incorrect procedures of storage or administration. Conducting surveillance of adverse events in the field is necessary for detecting unexpected increases in incidence of adverse events, for continuing education of health personnel involved in vaccine programs, for providing appropriate information to the public, and for supporting interventions to prevent further adverse events. Signals generated by surveillance systems may stimulate to conduct formal studies to assess causality.

Humans↗
PubMed2001

Dietary fat reduction strategies used by a group of adults aged 50 years and older.

OBJECTIVE: To investigate the fat-reduction strategies used by a group of older adults who successfully made and maintained positive dietary changes for 5 years or longer. DESIGN: Participants completed 2 copies of a self-administered food frequency questionaire: The first copy assessed diet before they began making changes and the second copy assessed diet after initiation of healthful dietary changes. Positive food changes were identified from the food frequency questionnaires. During in-person interviews, participants placed food changes onto a time line according to the nearest estimated date of initiation of the change. SUBJECTS: Participants were 65 free-living older adults (aged >50 years) who had maintained substantial changes to decrease fat intake in their diet for at least 5 years. Statistical analyses performed Quantitative and qualitative data were used to identify the fat-reduction strategies and to confirm and validate the fat-reduction strategy model. Confirmatory factor analysis was performed to confirm the new model. The Kuder-Richardson-20 reliability coefficient (kr) was used to determine internal consistency of the scales developed for the study. RESULTS: The majority of participants decreased their fat intake gradually, at different time points in their lives, and over a long period of time (5 to 43 years). Mean percent energy intake from fat decreased from 44.3 +/- 5.9% before dietary improvement to 25.9 +/- 7.1% at the time of the study. The final model consisted of 5 fat-reduction strategies with 63 food changes. The strategies were: increase summer fruits (4 items; kr=0.66), increase vegetables and grains (14 items; kr=0.79), decrease recreational foods (14 items; kr=0.76), decrease cooking fat (20 items; kr=0.86), and use fat-modified foods (11 items; kr=0.80). APPLICATIONS/CONCLUSIONS: Dietetics professionals should base their advice on the dietary strategies used by consumers rather than hypothetical premises such as food or nutrient groupings. Nutrition education interventions will have better chances for success if they are based on a set of customized programs that guide appropriate consumer segments through a series of small, comfortable, and sustainable dietary changes over a prolonged period of time.

Aged↗
PubMed1999

Current clinical practice in hypertension: the EISBERG (Evaluation and Interventions for Systolic Blood pressure Elevation-Regional and Global) project.

Hypertension is one of the major treatable factors contributing to the burden of disease worldwide. However, despite national programs to encourage detection and treatment, there are still shortcomings in hypertension management. A large proportion of these can be attributed to socioeconomic factors, professional shortcomings, and patient noncompliance with management regimens. The Evaluation and Interventions for Systolic Blood pressure Elevation-Regional and Global (EISBERG) project was conceived to examine the reasons for suboptimal management of hypertension in more detail. Emphasis was placed on control of elevated systolic blood pressure because this is often neglected despite evidence that it is more important than diastolic pressure in predicting cardiovascular risk. The goals of the project include analysis of the relative importance of systolic and diastolic blood pressure as cardiovascular risk factors, identification of any necessary changes in practice, and the development and implementation of programs to promote appropriate changes in practice or attitudes. The three components of the initiative are a formal collection of epidemiologic evidence to examine the relation between systolic blood pressure and outcome; a cross-sectional, quantitative database (CardioMonitor) providing information on the treatment of patients with cardiovascular diseases including hypertension in seven countries, and qualitative research into hypertension management to assess attitudes, awareness, and knowledge among primary care physicians, patients and their carers. The study showed more effort was directed toward control of diastolic than systolic blood pressure. Adequate control of systolic blood pressure was seldom achieved. Blood pressure targets tended to be raised in elderly patients in conflict with recommendations and evidence that there is greater benefit in treating hypertension more aggressively in this population. Despite awareness of guidelines for treating hypertension, doctors were unsuccessful in practice.

Adolescent↗
PubMed1996

The substance-using human immunodeficiency virus patient: approaches to outpatient management.

Individuals with a substance use disorder who are infected with human immunodeficiency virus (HIV) provide physicians with challenging issues for both medical management and drug treatment. Using a case presentation format, we present an overview of some of the major issues involved in delivering effective primary care for these individuals. A detailed medical and substance use history is critical to sort common complaints that can be seen both in HIV infection and with drug use. Physicians must be able to recognize withdrawal syndromes and differentiate those signs and symptoms that may be attributed to specific drugs. A two-phase model of drug abuse treatment takes into account both detoxification and maintenance of abstinence. Primary care physicians should be able to initiate the process of substance abuse treatment and refer the patient to appropriate substance abuse programs when necessary. Pharmacological approaches to long-term abstinence with heroin addiction include methadone, LAAM, and naltrexone. While clinically challenging, HIV-infected substance users can be successfully managed using the general principles of primary care.

Adult↗
PubMed1996

Peroneal stimulator; evaluation for the correction of spastic drop foot in hemiplegia.

OBJECTIVE: The objective of the study was to assess the orthotic and therapeutic value of the peroneal stimulator (PS) for adult hemiplegic patients. DESIGN: This was a two-period crossover study lasting 11 weeks. After recruitment each patient had a 4-week control period followed by a 4-week treatment period. The patients were assessed before the control period, after the control period, and after the treatment period. SETTING: Nineteen patients were recruited from physiotherapy departments in the Glasgow area; 2 subsequently dropped out before the treatment period. PATIENTS: All patients had hemiplegia as a result of cerebrovascular accident (CVA) and were greater than 3 months but less than 36 months post-CVA. Average time since stroke was 7 months. MAIN OUTCOME MEASURES: The patients' gait was assessed over smooth linoleum, carpet, and uneven ground. Gait was evaluated using a switch-based portable system. Outcome measures were the temporal gait parameters of speed, symmetry, heel strike, and foot inversion during stance. The gait evaluation was repeated on 5 separate days at each assessment. The Barthel Index was applied to each session. RESULTS: There was a significant orthotic improvement in inversion on all surfaces and for symmetry on linoleum (AN-OVA, p = .05). There was no significant improvement in patients' gait when not using the PS. There was a significant improvement in the Barthel Index over the treatment period (Wilcoxon, p = .05). CONCLUSION: Use of the PS an an orthotic device late in the rehabilitation program would be appropriate for a selected subpopulation of patients.

Adaptation, Physiological↗
PubMed1997

Systemic sclerosis (scleroderma): an integrated challenge in rehabilitation.

Systemic sclerosis (SSc), a multisystem disease involving the microvascular system and the connective tissue, is considered one of the most difficult rheumatic diseases to treat. The natural history of the disease evolves from an edematous to a scleroatrophic phase following two different temporal patterns: acute or chronic. The former leads to early death, and the latter evolves slowly toward severe disability that deserves rehabilitative intervention. Despite the poor prognosis, recent improvements in diagnosis and treatment have led to longer patient survival, thus increasing the need to intervene against the development of tissue fibrosis and contractures by using appropriate integrated rehabilitation programs. This article does not review the medico-pharmacological management of visceral manifestations of the disease. Rather, it is divided into six parts, which include analyses of the changes in skin, joints and tendons, and muscle induced by SSc; examination of the existing literature on rehabilitation strategies and treatments; discussions of the pain and peripheral sensory-motor system involvement that are present to a greater or lesser extent in almost all patients and influence not only the duration and outcome of rehabilitation but also the patient's family, social life, and working ability; and consideration of ergonomic and occupational interventions. No controlled studies have been done on the few rehabilitation guidelines and specific protocols identified, so it must be emphasized that this article is a summary of opinions expressed in the literature and the authors' own findings. Particularly lacking are studies on such aspects as ergonomics, work intervention, or the management of sexual dysfunction. Experience gained in the rehabilitation of skin burns and other rheumatic diseases forms the basis for a logical approach to SSc patients.

Acute Disease↗
PubMed1998

A blueprint for academic obstetrics and gynecology.

A consensus conference sponsored by the Council of University Chairs of Obstetrics and Gynecology in February 1997 formulated the organization's response to the many external issues affecting academic medicine and obstetrics and gynecology including 1) a new practice model based on "wellness," 2) reimbursement changes that have jeopardized traditional revenue sources, 3) an emphasis on quality assurance based on outcomes research and evidence-based medicine, 4) the concept of lifelong learning dictated by an expanding knowledge base and new technology, 5) insufficient resources for basic and clinical investigation in obstetrics and gynecology, 6) workforce statistics indicating stabilization in the number of subspecialists, 7) the increasing diversity of the United States population. Recommendations were developed that are intended to foster change and contribute to the design of academic programs. These include appropriate training for residents as providers of primary care, with an emphasis on continuity clinics, an interdisciplinary curriculum in women's health for medical students; promotion of gender, racial, and ethnic diversity at all levels of medical education and academic leadership; creation of clinical trials research units; and the development of expanded opportunities for research in obstetrics and gynecology supported by the National Institutes of Health.

Consensus Statements as Topic↗
PubMed1977

Nutritional management of the chronically ill child. Congenital heart disease and myelomeningocele.

We have presented some of the nutritional complications encountered in two major pediatric congenital disorders. Although these conditions represent two more common major defects, it is unlikely that many health care providers will manage large numbers of these patients. Nevertheless, the nutrition principles apply to other nutritional dilemmas of chronically ill children. When an infant consumes a low volume intake, regardless of etiology, concerns such as provision of adequate nutrition, within the confines of the infant's water balance, become paramount. Methods have been discussed for increasing caloric density and for monitoring dietary safety and adequacy. When an infant has a propensity for becoming obese one needs to consider preventive measures such as providing sound nutrition information, support, and follow-up for both patient and family. Nutritional problems can become magnified unless adequate support is provided for total health and social needs of the family. The role of the dietitian must be one active participation within the the framework of an interdisciplianry team so that appropriate innovative nutrition programs can be developed and implemented.

Child, Preschool↗
PubMed1978

Visceral larva migrans and alveolar hydatid disease. Dangers real or imagined.

For both visceral larva migrans and alveolar hydatid diseases, it is the feces of companion animals that are the primary source of human infection. Clearly, whatever is done to reduce this form of environmental contamination and the prevalence of the parasites' infective stages will help to protect the health of the human population in the United States and Canada, particularly the children. Very important are appropriate anthelmintic treatment programs, especially for T. canis, and proper control of close associations between pets and people. Probably the known incidence of visceral larva migrans in humans and the range of its known pathogenicity will increase as better diagnostic methods become available. In addition, other animal helminths, for instance Toxocara cati and Toxascaris leonina, may become more substantially documented as causes of human visceral larva migrans. Until more is known of the geographical distribution and prevalence of Echinococcus multilocularis among animals in North America, it will be difficult to assess accurately the future significance of alveolar hydatid disease in the continent's human population. Another important advance would be the development of anthelmintics that are effective for somatic second stage larvae of T. canis, and others effective for adult or larval Echinococcus species. Meanwhile it is a most important responsibility of the veterinary profession to educate its clients thoroughly concerning these dangerous helminths.

Animals↗
PubMed1993

Feline leukemia virus. Immunization and prevention.

Our understanding of the pathogenesis of FeLV infection is little changed from what was described by Hardy and his colleagues in the mid-1970s. The prevention of FeLV infection consists, first, of avoiding the agent and, second, of providing optimum immunologic resistance. In multi-cat environments, the former is achieved through test-and-removal methods perennially reviewed in the literature and by minimizing exposure to outdoor cats. The latter is possible by attempting to maintain a low-stress, pathogen-free household and by the use of appropriate, effective immunization programs. Simple immunologic concepts used for the development of vaccines against feline distemper and rabies have evolved to enable generation of products that can now protect against retroviruses. The use of more complex biologic methods, such as recombinant technology and the manipulation of antigen presentation, bears encouragement, so that perhaps one day the most destructive of feline infectious diseases may be checked.

Animals↗
PubMed1999

Problems of long-term spinal opioid treatment in advanced cancer patients.

Epidural and intrathecal techniques are well established techniques in cancer pain. However, several questions remain unresolved. The several problems of long-term spinal opioid treatment in advance cancer patients were reviewed. Indications for the use of spinal opioids include patients treated by systemic opioids with effective pain relief but with unacceptable side effects, or unsuccessful treatment with sequential strong opioid drug trials despite escalating doses. Therefore, the previous aggressive treatment with systemic opioids would leave as failures patients with difficult pain syndromes unresponsive to opioids. The choice of external or totally implanted delivery systems is based on different clinical considerations. The use of externalized tunneled intrathecal catheters has not been associated with higher rates of complications and is easier to place and use at home in debilitated patients late in the course of their disease. The intrathecal administration has a lower incidence of catheter occlusion, lower malfunctioning rate, lower dose requirement, and more effective pain control. Due to the lower daily doses and volumes, intrathecal treatment proved to be more suitable for treatment at home by a continuous infusion than the epidural treatment. Advantages of infusion techniques are more evident when using local anesthetics, since intermittent administration of bupivacaine often results in motor paralysis and hemodynamic instability. Morphine is the opioid of choice. An epidural dose of 10% of the systemic dose is often used. However, intrathecal administration of opioids and bupivacaine may substantially improve pain relief in patients unresponsive to high epidural doses of these drugs, Bupivacaine-induced adverse effects, including sensory deficits, motor complaints, signs of autonomic dysfunction or neurotoxicity have been reported to not occur with bupivacaine doses less than 30-60 mg/day. Adjuvant drugs may further improve analgesia. Different ranges of technical complication rates have been reported in the literature, most of them being associated with epidural catheters. Subcutaneous tunneling and fixation of the catheter, bacterial filters, minimum changes of tubings, careful exit site care weekly, site protection and monitoring of any sign of infection to prevent infection, and training for family under supervision, are recommended. Areas for additional research include the use of spinal adjuvants, the ideal spinal morphine-bupivacaine ratio. methods to improve spinal opioid responsiveness and long-term catheter management with appropriate home care programs.

Analgesia, Epidural↗
PubMed2003

Routine IMRT verification by means of an automated Monte Carlo simulation system.

PURPOSE: A tool to simulate complete intensity-modulated radiation therapy (IMRT) treatments with the Monte Carlo (MC) method has been developed. This application is based on a distribution model to employ as short processing times as possible for an operative verification. MATERIALS AND METHODS: The Clinical Primus-Siemens Linac beam was simulated with MC, using the EGS4 OMEGA-BEAM code package. An additional home-made program prepares the appropriate parameters for the code, using as input the file sent from the planning system to the linac. These parameters are adapted to the simulation code, making physical and clinical subdivisions of the global simulation of the treatment. Each resultant partition is ordered to a client personal computer in a cluster with 47 machines under a Linux environment. The verification procedure starts delivering the treatment on a plastic phantom containing an ionization chamber. If differences are less than 2%, films are inserted at selected planes in the phantom and the treatment is delivered again to evaluate the relative doses. When matching between treatment planning system (TPS), film, and MC is acceptable, a new evaluation of the patient is then performed between TPS and MC. Three different cases are shown to prove the applicability of the verification model. RESULTS: Acceptable agreement between the three methods used was obtained. The results are presented using different analysis tools. The actual time employed to simulate the total treatment in each case was no more than 5 h, depending on the number of segments. CONCLUSIONS: The MC model presented is fully automated, and results can be achieved within the operative time limits. The procedure is a reliable tool to verify any IMRT treatment.

Adenocarcinoma↗
PubMed1994

In utero infections responsible for abortion, stillbirth, and birth of weak calves in beef cows.

A multitude of in utero infections may cause abortion, stillbirths, or the birth of weak calves (see Table 1). Because the diagnostic success for determining the cause of abortions may be low (25%-40%), it is important that more knowledge about the causes and differential diagnoses is gained, and proper samples are collected and submitted. Use of an abortion diagnosis kit enables multiple samples to be analyzed and increases the likelihood of making a diagnosis. The immune response is suppressed during pregnancy. In part, this can be controlled by proper nutrition and appropriately timed vaccination programs.

Abortion, Veterinary↗