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PubMed2006

Specialized neurocritical care, severity grade, and outcome of patients with aneurysmal subarachnoid hemorrhage.

INTRODUCTION: To evaluate the impact of specialized neurocritical care on the population admitted to a neurovascular center and on the outcome of patients with severe aneurysmal subarachnoid hemorrhage (aSAH). METHODS: After exclusion of patients treated with endovascular techniques, between 1999 and 2003, 198 patients with aSAH treated with early aneurysm clipping were analysed. In 1999, a new standardized protocol for intensive care treatment was established in the Department of Neurosurgery, University Hospital Zurich. The results were compared to the earlier time period (1993-1994) immediately after introduction of early aneurysm clipping. RESULTS: Out of 198 patients with aSAH, 90 patients (45.5%) suffered from mild aSAH World Federation of Neurosurgical Societies (WFNS) grade 1 and 2, 41 (27.3%) from aSAH WFNS grade 3, 36 (18.2%) from grade 4, and 57 (28.8%) from grade 5. From 1999 to 2003, significantly more patients with severe aSAH WFNS grade 4 and 5 underwent (further) treatment (93 out of 198 patients; 47.0%) compared to the former time-period after introduction of early surgery (23 out of 150 patients; 15.3%) (p < 0.0001). In the early series, 10 out of 23 patients (43.5%) with WFNS 4 recovered with good outcome Glasgow Outcome Score 4 and 5, whereas in the later series 23 out of 36 (63.9%) with WFNS grade 4 survived in a good functional state. Before 1999, all patients with WFNS grade 5 died or survived in a vegetative state. From 1999 to 2003, 20 out of 57 patients (35.1%) with aSAH WFNS grade 5 survived with good outcome. CONCLUSIONS: The availability of extended specialized neurocritical care seems to induce a change within the patient population towards a higher severity grade. Patients with highgrade aSAH might benefit most from highly specialized neurocritical care treatment.

Adult↗
PubMed1988

Drinking under special occasion permits: a neglected aspect of alcohol control measures?

Drinking that occurs under special permits in Canada, such as at weddings, private receptions and parties, is a neglected aspect of alcohol research. These permits are issued for many different occasions and are most common in the provinces with the highest per capita alcohol consumption. Special permit drinking is becoming a social and alcohol-control issue but information on the problems it creates is sparse. Specific problem areas such as excessive drinking and drinking by minors have not been studied, but because such drinking is rarely monitored they may be substantial. Further study of special permit drinking is recommended.

Alcohol Drinking↗
PubMed1991

Special treatment facilities for alcoholics in Japan.

No comprehensive study on special treatment facilities for alcoholics in Japan has been reported. We conducted a questionnaire survey of alcoholism treatment wards, alcoholism treatment rooms, special outpatient clinics for alcoholics and halfway houses for alcoholics. The survey covered nearly all of such facilities in Japan. The results of the survey revealed the following characteristics: (1) The number of such facilities has increased rapidly in recent years; (2) the facilities are concentrated in cities; (3) the great majority of the facilities are privately operated; (4) many of the facilities are associated with psychiatric departments; and (5) there are very few facilities exclusively for female alcoholics. The most fundamental and important point is that the number of special treatment facilities for alcoholics is insufficient to meet current needs. These facilities have not diversified sufficiently to address adequately the changing needs of Japanese alcoholics.

Alcoholism↗
PubMed2000

Use of telemedicine for children with special health care needs.

OBJECTIVE: In 1995, the Children's Medical Services (CMS) of the State of Georgia contracted with the Department of Pediatrics of the Medical College of Georgia (MCG) and the MCG Telemedicine Center to develop telemedicine programs to provide subspecialty care for children with special health care needs. This article presents project statistics and results of client evaluation of services, as well as physician faculty attitudes toward telemedicine. DESIGN: A demonstration project using telemedicine between a tertiary center and a rural clinic serving children with special health care needs was established. Data were collected and analyzed for December 12, 1995 to May 31, 1997, during which 333 CMS telemedicine consultations were performed. RESULTS: Most CMS telemedicine consultations (35%) involved pediatric allergy/immunology. Other subspecialties included pulmonology (29%), neurology (19%), and genetics (16%). Overall, patients were satisfied with the services received. Initially, physician faculty members were generally positive but conservative in their attitudes toward using telemedicine for delivering clinical consultation. After a year's exposure and/or experience with telemedicine, 28% were more positive, 66% were the same, and only 4% were more negative about telemedicine. The more physicians used telemedicine, the more positive they were about it (r =.30). CONCLUSIONS: In terms of family attitudes and individual care, telemedicine is an acceptable means of delivering specific pediatric subspecialty consultation services to children with special health care needs, living in rural areas distant to tertiary centers. Telemedicine is more likely to be successful as part of an integrated health services delivery than when it is the sole mode used for delivery of care.

Adolescent↗
PubMed2003

Use of complementary and alternative medical therapies among children with special health care needs in southern Arizona.

OBJECTIVE: The objective of this study was to assess the frequency and type of complementary and alternative medicine (CAM) therapies used by families of children with special health care needs in southern Arizona, as well as the correlates of their use. METHODS: Families of 376 children who were receiving services in a regional facility that serves children with special health care needs and were residing in southern Arizona were surveyed regarding CAM use. RESULTS: Sixty-four percent of these families reported using CAM for their child. The most common CAM therapies were spiritual healing/prayer/blessings. Of the conditions that were evaluated as correctable, the use rate was 24% as compared with a 76% use rate for children with a nonrepairable condition. Use of CAM for the child was strongly related to the use of CAM in the past by the family member who responded to the survey. The reasons that parents most frequently chose for using CAM were advice from a medical practitioner and advice from a family member. CONCLUSIONS: Use of CAM for children with special health care needs is common. Its frequency and type are significantly associated with the child's condition and prognosis.

Adolescent↗
PubMed2003

Reimbursement for foods for special dietary use.

Foods for special dietary use are recommended by physicians for chronic diseases or conditions of childhood, including inherited metabolic diseases. Although many states have created legislation requiring reimbursement for foods for special dietary use, legislation is now needed to mandate consistent coverage and reimbursement for foods for special dietary use and related support services with accepted medical benefit for children with designated medical conditions.

Chronic Disease↗
PubMed2005

Addressing transition to adult health care for adolescents with special health care needs.

OBJECTIVE: To determine the factors associated with addressing the transition from pediatric to adult-oriented health care among US adolescents with special health care needs. METHODS: Data for 4332 adolescents, 14 to 17 years of age, from the 2000-2001 National Survey of Children With Special Health Care Needs were used. The adequacy of transition services was determined by parent self-report. Explanatory variables, including parental education, family poverty status, race/ethnicity, measures of the severity and complexity of conditions, health insurance status, having a personal doctor, and the quality of the parent's relationship with the adolescent's doctor, were entered into a regression model. RESULTS: Overall, 50.2% of parents reported that they had discussed transition issues with their adolescent's doctor and 16.4% had discussed and developed a plan for addressing those needs. In a multivariate regression analysis, correlates of the adequacy of transition services included older age, female gender, complexity of health care needs, and higher quality of the parent-doctor relationship. CONCLUSIONS: Among adolescents with special health care needs, those who were older and those with more complicated needs were more likely to have addressed the transition from a pediatric to adult-oriented system of care. Furthermore, this analysis demonstrated a strong association between a high-quality parent-provider relationship and the extent to which transition issues were addressed. The importance of transition services for adolescents with less complex needs and the overall impact of health care transition services were not assessed in this study and remain important questions for future investigations.

Adolescent↗
PubMed2005

Association between underinsurance and access to care among children with special health care needs in the United States.

OBJECTIVE: To examine the impact of underinsurance on access to care among children with special health care needs (CSHCN) in the United States. METHODS: Interviews were conducted by telephone with the families of 38866 CSHCN who were younger than 18 years using the 2001 National Survey of Children With Special Health Care Needs. The prevalence of underinsurance and its relationship to access to care and family financial problems was examined in this cross-sectional analysis. CSHCN were classified as underinsured when coverage was deemed inadequate to meet the child's needs. RESULTS: An estimated 12.8% of US children experienced a special health care need in 2001. Although 95% of CSHCN had some type of insurance coverage at the time of the interview, 32% were classified as underinsured. Underinsured CSHCN were disproportionately represented in low-income families and were significantly more likely than fully insured children to have unmet health needs, and their families were more likely to report difficulty in obtaining specialty referrals, experience financial problems, and report that the child's condition caused family members to reduce or stop work. Underinsured CSHCN seemed to be somewhat better off than CSHCN with no insurance coverage on these measures. CONCLUSIONS: Underinsured CSHCN represent an important and largely hidden underserved population.

Child↗
PubMed2005

Helping families raise children with special health care needs at home.

One goal of Healthy People 2010 is to reduce the number of people with disabilities in congregate care facilities, consistent with permanency-planning principles, to 0 by 2010 for persons aged 21 years and under (objective 6-7). Congregate care, in this regard, is defined as any setting in which 4 or more persons with disabilities reside, regardless of whether the residence is located in the community, such as a school, group home, nursing facility, or institution. Although this particular public health objective may reflect an unfamiliar concept for some pediatricians, the American Academy of Pediatrics supports the goals and objectives of Healthy People 2010 as well as the medical home and the provision of community-based, culturally effective, coordinated, and comprehensive care for children with special health care needs and their families. To advise families caring for children with special health care needs effectively, the pediatrician should be familiar with the principles of permanency planning and well informed of local family-support services. The pediatrician should also work with the family to identify the range of long-term supports and services available for their child. These supports may include respite for biological families as well as various additional parenting models such as shared parenting, foster care, alternate parents, and adoption. Although family-based supports are preferable, families may consider other out-of-home placements including group homes, placement in a nursing facility, or other forms of institutional care when sufficient family-based services are not available. Once all the options are understood, issues regarding quality of care can be individualized and judged by the parent or guardian, in close collaboration with the pediatrician and other professionals with expertise in permanency planning and long-term supports and services. The purpose of this clinical report is to educate physicians on the philosophy of providing a permanent family environment (permanency planning) for all children, including those with special health care needs, and the importance of adequate and accessible community services to support and maintain the well-being of all family members.

Adolescent↗
PubMed2006

Chronic conditions, functional limitations, and special health care needs in 10- to 12-year-old children born at 23 to 25 weeks' gestation in the 1990s: a Swedish national prospective follow-up study.

BACKGROUND: Children born extremely immature (gestational age < 26 weeks' gestation) increasingly reach school age. Information on their overall functioning and special health care needs is necessary to plan for their medical and educational services. This study was undertaken to examine neurosensory, medical, and developmental conditions together with functional limitations and special health care needs of extremely immature children compared with control subjects born at term. METHODS: We studied 11-year-old children born before 26 completed weeks of gestation in all of Sweden from 1990 through 1992. All had been evaluated at 36 months' corrected age. Identification of children with chronic conditions lasting > or = 12 months was based on a questionnaire administered to parents. Neurosensory impairments were identified by reviewing health records. Information regarding other specific medical diagnoses and developmental disabilities was obtained by standard parent and teacher questionnaires. RESULTS: Of 89 eligible children, 86 (97%) were studied at a mean age of 11 years. An equal number of children born at term served as controls. Logistic-regression analyses adjusting for social risk factors and gender showed that significantly more extremely immature children than controls had chronic conditions, including functional limitations (64% vs 11%, respectively), compensatory dependency needs (59% vs 25%), and services above those routinely required by children (67% vs 22%). Specific diagnoses or disabilities with higher rates in extremely immature children than in controls included neurosensory impairment (15% vs 2%), asthma (20% vs 6%), poor motor skills of > 2 SDs above the mean (26% vs 3%), poor visual perception of > 2 SDs above the mean (21% vs 4%), poor learning skills of > 2 SDs above the mean (27% vs 3%), poor adaptive functioning with T scores of < 40 (42% vs 9%), and poor academic performance with T score < 40 (49% vs 7%). CONCLUSIONS: Children born extremely immature have significantly greater health problems and special health care needs at 11 years of age. However, few children have severe impairments that curtail major activities of daily living.

Child↗
PubMed2001

Evolutionary dynamics of host-plant specialization: a case study of the tribe Nymphalini.

Two general patterns that have emerged from the intense studies on insect-host plant associations are a predominance of specialists over generalists and a taxonomic conservatism in host-plant use. In most insect-host plant systems, explanations for these patterns must be based on biases in the processes of host colonizations, host shifts, and specialization, rather than cospeciation. In the present paper, we investigate changes in host range in the nymphalid butterfly tribe Nymphalini, using parsimony optimizations of host-plant data on the butterfly phylogeny. In addition, we performed larval establishment tests to search for larval capacity to feed and survive on plants that have been lost from the female egg-laying repertoire. Optimizations suggested an ancestral association with Urticaceae, and most of the tested species showed a capacity to feed on Urtica dioica regardless of actual host-plant use. In addition, there was a bias among the successful establishments on nonhosts toward plants that are used as hosts by other species in the Nymphalini. An increased likelihood of colonizing ancestral or related plants could also provide an alternative explanation for the observed pattern that some plant families appear to have been colonized independently several times in the tribe. We also show that there is no directionality in host range evolution toward increased specialization, that is, specialization is not a dead end. Instead, changes in host range show a very dynamic pattern.

Animals↗
PubMed1994

[Nurses specialized in neuroscience. A necessity?].

A specialization in nursing seems to be a preoccupation of several professional as a means to improve the professional practical. Specifically, the neuroscience nursing expression makes thought in a possible area which the nurses could develop and specialize themselves. The present report shows some enlightenment on what neuroscience nursing is, the actuation possibilities for the nurses and what could be developed in a specialization course, based in american literature.

Health Services Needs and Demand↗
PubMedDate not supplied

[Keratoconus special soft contact lens fitting].

PURPOSE: To evaluate the fitting and use of a soft contact lens in keratoconic patients. METHODS: Retrospective study on 80 eyes of 66 patients, fitted with a special soft contact lens for keratoconus, at the Contact Lens Section of UNIFESP and private clinics. Keratoconus was classified according to degrees of disease severity by keratometric pattern. Age, gender, diagnosis, keratometry, visual acuity, spherical equivalent (SE), base curve and clinical indication were recorded. RESULTS: Of 66 patients (80 eyes) with keratoconus the mean age was 29 years, 51.5% were men and 48.5% women. According to the groups: 15.0% were incipient, 53.7% moderate, 26.3% advanced and 5.0% were severe. The majority of the eyes of patients using contact lenses (91.25%) achieved visual acuity better than 20/40. To 88 eyes 58% were tihed with lens with spherical power (mean -5.45 diopters) and 41% with spherocylinder power (from -0.5 to -5.00 cylindrical diopters). The most frequent base curve was 7.6 in 61% of the eyes. The main reasons for this special lens fitting were due to reduced tolerance and poor fitting pattern achieved with other lenses. CONCLUSION: The special soft contact lens is useful in fitting difficult keratoconic patients by offering comfort and improving visual rehabilitation that may allow more patients to postpone the need for corneal transplant.

Adolescent↗
PubMed1997

[A critical analysis of medical specialities and strategies for their integration into the Unified National Health System in Brazil]

The implementation of medical specialization in Brasil has been relatively free of constraints. There has thus been a progressive fragmentation of medical work. The so-called root specialities are losing both their strength and clinical problem-solving capacity. Two operational concepts are proposed for achieving better administration of medical responsibilities and the role of medical professionals: 1) field of competence and 2) core competence. General goals are suggested for reforming specialized training and integration of specialists into the Unified National Health System.

Journal Article↗
PubMed2000

[Nursing specialization program: residential model: experience of establishing oneself in a teaching hospital].

This is a report about the experience of setting up a Specialization Program for Nurses in a "Residence" format, at the school-hospital of the Federal University of São Paulo, which mixes the traditional structure of specialization programs in Brazil with the model of the resident physician practical training. It began on February 1995, with the following objectives: 1) to qualify nurses, in different specialities, by an intensive training program, on a full-time schedule; 2) to contribute to improve the process of nursing care and; 3) to increase the quality of nursing assistance in our hospital. The results of our experience allow us to suggest that's a good way to qualify nurses for the best nursing practice, and to increase nursing research in a very practical basis.

Brazil↗
PubMed2000

Ultrastructural and histochemical characterization of special muscle cells in the monkey small intestine.

The ultrastructure, three-dimensional arrangement, and histochemical features of special muscle cells in the monkey small intestine were investigated. The cells formed a special layer separated from the main part by a connective tissue space along the submucosal surface of the circular muscle coat. Scanning electron microscopy using alkali maceration demonstrated this inner sublayer to be a continuous thin sheet consisting of irregularly-shaped muscle cells equipped with many cytoplasmic projections and caveolae. Other ultrastructural features included direct contact with interstitial cells, due to their close association with nerve fibers of the deep muscular plexus. Histochemical examination revealed significant alkaline phosphatase activity and immunoreactivity for vascular smooth muscle alpha actin in these muscle cells, whereas the ordinary circular muscle cells were immunopositive for enteric smooth muscle gamma actin. These findings suggest that the special muscle cells play an important role in regulating the radial stretch of the monkey small intestinal wall.

Actins↗
PubMed1991

The effects of specialized training in alcohol information for counseling students.

The alcoholism problem in the United States has reached proportions impossible to ignore. It follows that we need trained professionals in significant numbers to deal with the alcoholic population. Graduate programs, however, provide little or no course offerings in the area of specific training for dealing with alcoholics. In academia some attempts have been made to address this situation. However, budget restrictions, limited marketability of counselors with specialized training, and the superiority of the generalist training model are some of the main arguments that have compromised adequate chemical dependence training. The research literature, however, is replete with studies indicating the need for specialized training to prepare mental health professionals to work as competent alcohol counselors. The focus of this research was to examine the effect of specific training for counseling students in preparing them to work with alcoholic clients. The results of the analyses indicated that a training session specifically designed for working with alcoholic populations significantly increased the objective knowledge base of counseling students, although the single training session was not enough to significantly improve subjective judgment and response scores. This research emphasizes a need for specialized training in counseling programs for alcohol counselors. Further, it is implied that training programs should include at least one semester-long course on alcohol remediation for counseling students.

Alcohol Drinking↗
PubMedDate not supplied

[Some specificities of rehabilitation of children with special needs].

INTRODUCTION: Children with special needs (with psychophysical developmental disabilities) need rehabilitation in order to live as independent life as possible. The aim of this study was to determine the amount of certain kinds of rehabilitation in children with special needs. MATERIAL AND METHODS: The study included three groups of children (total of 99 children) hospitalized at the department for extended treatment of the rehabilitation center for children. All children have mental, physical or combined disabilities, as a result of chronic disease. Treatment type and the amount (and also involvement in special schools) depended on the disability. Analysis of sex distribution showed male predominance. Most children (59 of them) were aged 0-7 (59.6%) and there were 40 children 8-17 (40.4%) years old. RESULTS: Most of the subject were involved in: occupational therapy 93 (36.8%), kinesitherapy 47 subjects (18.6%), psychomotor therapy 46 (18.2%), speach therapy 35 (13.8%), and medical therapy 32 (12.6%). School children were mostly with mental disability.

Adolescent↗