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PubMed1987

Hemophiliac patient's knowledge and educational needs concerning acquired immunodeficiency syndrome.

The Patient Knowledge Assessment Study (PKAS) was conducted among 107 male hemophilic patients, aged 15 to 67 years, at 19 hemophilia treatment centers (HTC). Participants were given a 30-item questionnaire concerning the cause of acquired immunodeficiency syndrome (AIDS), the groups at risk, and modes of transmission. The questionnaire included questions on the participant's status in regard to antibody to human T-lymphotropic retrovirus, type III/lymphadenopathy-associated virus (HTLV-III/LAV), and the meaning of this test result. HTC health-care providers were asked to complete a separate questionnaire containing 17 questions about information given patients concerning their HTLV-III/LAV antibody status and its meaning. Overall, patients had a good base of knowledge about AIDS; however, there were gaps in this knowledge. Twenty-nine percent of patients did not know that spouses of AIDS patients were at risk for AIDS; 47% did not know that sexual partners of persons with hemophilia were at risk; and 32% did not know that hemophilic children were at risk. Further, only 69% understood that antibody-positive individuals had had contact with the AIDS virus. Identifying these and other areas of misunderstanding will provide the information needed to design educational strategies and psychosocial support programs appropriate for the hemophilic population, and which may serve as a model for other populations.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Repetitive reentrant and non-reentrant ventriculoatrial synchrony in dual chamber pacing.

Repetitive retrograde ventriculoatrial (VA) conduction in patients with dual chamber pacemakers may cause two forms of VA synchrony. (1) Endless loop tachycardia (pacemaker-mediated tachycardia) or repetitive reentrant VA synchrony occurs when the pacemaker senses retrograde P waves. Appropriate programming can prevent pacemaker reentrant tachycardia in almost all cases. However, the measures used to control tachycardia may themselves create new problems. (2) AV desynchronization arrhythmia or repetitive non-reentrant AV synchrony occurs when the pacemaker does not sense retrograde P waves. In this form of VA synchrony, the atrial stimulus is ineffectual because it falls in the atrial myocardial refractory period generated by the preceding unsensed retrograde P wave. A long atrioventricular interval and a relatively fast lower rate (or sensor-driven rate with DDDR pacing) favor the development of AV desynchronization arrhythmia and its unfavorable hemodynamic consequences.

Cardiac Complexes, Premature↗
PubMed2000

DDD and single-lead VDD pacing: evaluation of atrial signal dynamic changes.

BACKGROUND: Single-lead VDD pacing systems are an alternative to conventional DDD pacemakers in patients with atrioventricular (AV) block and normal sinus function. HYPOTHESIS: The aim of this study was to assess changes of P-wave amplitude occurring in dynamic conditions in two groups of patients with a single-lead VDD and with a DDD pacing system, respectively. METHODS: Twenty-eight patients with second- or third-degree AV block and normal sinus function were enrolled prospectively into the study. Seventeen patients were implanted with a single-lead VDD pacing system and 11 with a DDD pacemaker. Patients were evaluated at 3 months (all patients) and at 6 months (26 patients) at supine and in dynamic conditions (postural changes, hyperventilation, and during exercise). RESULTS: Mean P-wave values at supine were 1.92 +/- 1.10 mV at 3 months and 1.76 +/- 1.01 mV at 6 months for VDD systems, and 4.63 +/- 2.18 mV at 3 months and 4.58 +/- 2.80 mV at 6 months for DDD pacemakers. In dynamic conditions, P-wave amplitude changes compared with supine condition ranged between -74 and +226% in VDD, and between -53 and +138% in DDD; however P-wave amplitudes showed no significant changes compared with baseline. Moreover, changes in atrial signal amplitudes did not occur randomly, and in both systems P-wave amplitudes remained significantly correlated with supine values. CONCLUSIONS: A wide range of P-wave amplitude variations occurs in different postural conditions or during exercise, both with single-lead VDD and DDD pacing systems. However, with appropriate programming of atrial sensitivity based on supine values, constant atrial tracking can be maintained.

Aged↗
PubMed1995

Prevalence and secular trends in obesity in Pacific and Indian Ocean island populations.

Surveys conducted in 10 Pacific island populations and in the multiethnic populations of Mauritius and Rodrigues in the Indian Ocean have provided data on the prevalence of obesity, potential etiological factors and medical hazards associated with obesity. The results indicate that the prevalence of obesity (by body mass index (BMI) in some of these populations is among the highest in the world. Obesity related to degree of modernization is more common in urban than in rural locations and tends to be found more often in women. In two populations where longitudinal data were available, there were dramatic increases in prevalence over relatively short time periods. Obesity contributed to the risk of non-insulin-dependent diabetes mellitus (NIDDM) and was associated with other risk factors for cardiovascular disease (CVD) in all populations, but no relationship could be found with total mortality in three ethnic groups for whom data were available. A genetic susceptibility to obesity combined with social pressures that favor high energy intakes and reduced physical activity are believed to be important in these populations. The challenge for the future lies in developing culturally appropriate programs for preventing obesity and thus reducing associated morbidity, while continuing to research its behavioral and genetic determinants.

Adult↗
PubMed1996

Sex masks: the double life of female commercial sex workers in Mexico City.

The central topic of the article is the divided world of female commercial sex workers (FCSW) in Mexico City. Fourteen focus group sessions were conducted with 133 FCSW from varying socio-economic levels and types of work site, as well as seven individual interviews. FCSW live in a constant double bind, as mother and "prostitute," and come into daily contact with society's double standard for women. Reactions include justifying sex work as a better paying employment opportunity for women, as a necessary evil, and as a type of social service, while at the same time hiding their profession from their families. FCSW also live out an archetypal female ambivalence, their selves divided between the mother/"saint" and the traitor/"prostitute." This article defines elements which should be taken into account in culturally appropriate programs for prevention of HIV/AIDS transmission, especially the importance which FCSW give to their role as mothers and promotion of the condom as a physical and symbolic barrier between professional and private life.

Condoms↗
PubMed1996

Selection of motor responses on the basis of unperceived stimuli.

In a previous study, the sensory phenomenon of "backward masking" was used to demonstrate that subjects can preprogram a single stereotyped voluntary movement or movement-sequence and that such a movement can be triggered in response to a stimulus that is not perceived (that is, a stimulus of which the subject is unaware). In the present study, visual stimuli were presented at random in one of two different locations to normal human subjects in a choice reaction-time (RT) task. When the stimulus appeared in one of the locations, subjects made a motor response. When the stimulus appeared in the other location, subjects made a different motor response. Large and small stimuli were presented in either location. In some trials, the small stimulus was followed 50 ms later by the large stimulus. The small stimulus was then "masked" by the large stimulus and could not be perceived on forced-choice testing. Despite not perceiving the test stimulus in either of its randomly selected locations, subjects were able to select and execute the motor response appropriate for each location. The RTs for responses to the masked stimulus and to the same stimulus presented without masking (and so, easily perceived) were the same. This result implies that appropriate programs for two separate movements can be simultaneously held ready for use, and that either one can be executed when triggered by specific stimuli without subjective awareness of such stimuli and so without further voluntary elaboration in response to such awareness.

Analysis of Variance↗
PubMed1991

Experiences of a health team working in a new urban settlement area in Istanbul.

A project aiming at creating a model for comprehensive maternal and child health care for urban underdeveloped areas was started in a new settlement area of migrants in the vicinity of Istanbul. The project had an impact on health care status, particularly among infants and children, but the results indicated that more effort was needed to reach the mothers. It was noted that building space and the appearance of the work place influenced the prestige of the team. Absentee problems could be partly surmounted by repeated home visits. Based on this experience, it was concluded that health services in underdeveloped areas need to be supported by non medical personnel to act as home visitors and as mediators between the community and the health team. It was also concluded that an established recording system to include both clinical data and attendance is needed to define the cases who need special care.

Adult↗
PubMed1995

Treatment of surgical and non-surgical septic multiorgan failure with bicarbonate hemodialysis and sequential hemofiltration.

OBJECTIVE: Hospital mortality of patients with septic multiorgan failure (MOF) is still around 95%. The present study investigates whether this high mortality could be significantly reduced by the addition of sequential hemofiltration (SH) with bicarbonate hemodialysis (HD) to the currently used life supportive measures. DESIGN: 35 (18 surgical and 17 nonsurgical) patients, with 3 or more organ failures, had daily sessions of zero balance SH, for periods ranging from 2-22 days. MEASUREMENTS AND RESULTS: SH induced significant improvement of PaO2/100 FIO2, Apache II score, MAP, as well as blood chemistry in survivors. Dying patients had less marked improvement of blood oxygenation, non-significant changes in other variables, in addition to low MAP before and after SH, as well as marked hemodynamic unstability during the procedure. The observed hospital mortality was 38% for the surgical group, and 35.3% for the medical patients (n.s.). CONCLUSIONS: Mortality observed in this retrospective, uncontrolled study was significantly lower than that currently observed with conventional supportive therapy, with or without the addition of other forms of blood purification, e.g. CAVH and CAVHD. This improvement in results appears to be related to the property of SH to completely clear 90% of the blood from mediators of inflammation in only one passage through the hemofilter, and to better tolerance of HD done using bicarbonate buffer. A definite evaluation of this technique will be eventually reached by a programmed, appropriate sample size study, which is out of reach for one individual ICU.

Adult↗
PubMed1992

Providing culturally appropriate mental health services for minorities.

Research on the use of outpatient mental health services has shown lower rates of utilization by minorities. Barriers include economic considerations, access difficulties, and cultural factors. Promoting the use of outpatient mental health services by minorities can have a positive effect on the overall cost of health and mental health care, as well as increasing access to care and quality of care for minority populations. Advantages and disadvantages of various approaches to providing culturally appropriate programming in mental health services are discussed.

Cultural Characteristics↗
PubMed1986

Preterm labor: its diagnosis and management.

Preterm labor and delivery remain a significant problem in contemporary obstetric practice. Although the exact cause remains unclear, it is most likely to be multifactorial in nature. No satisfactory screening tool or marker currently exists to firmly establish the diagnosis of impending labor. However, epidemiologic and historical variables associated with preterm delivery show some promise in this regard and are currently being evaluated in preterm prevention programs. Appropriate management of preterm labor mandates early recognition of subtle signs and symptoms; successful therapy is dependent on this issue. The approach to the clinical management of the patient in preterm labor used at our institution is described. Therapy with beta-adrenergic receptor agonists is currently the recommended pharmacologic treatment of this disorder. A review of other tocolytic agents and their usefulness in the management of preterm labor are presented.

Adolescent↗
PubMed1982

Clustering of chronic disorders--a community study of coprevalence in Jerusalem.

Associations between chronic disorders were appraised in a community survey in western Jerusalem in order to identify clusters of mutually related conditions. Two sets of interrelated diseases were observed. The first comprised coronary heart disease, hypertension, diabetes and their complications. The second included migraine and other chronic disorders whose diagnosis was largely based on subjective symptoms. The presence of these complaint-based disorders was associated with a high prevalence of emotional symptoms, with reported difficulties in the life situation, and with frequent doctor visits. The design of appropriate programs of preventive and therapeutic intervention for this cluster of disorders remains an important challenge.

Adult↗
PubMed1986

Rat apolipoprotein A-IV: application of computational methods for studying the structure, function, and evolution of a protein.

There are a great variety of computational methods available to study protein and nucleic acid sequences. The choice of a computer program appropriate to a particular problem and the critical interpretation of the results can lead to specific, and experimentally testable, predictions of a protein's structure and function and may yield insights into its evolution and the location of its gene. We have shown that rat apoA-IV bears a striking structural similarity to human apoA-I (summarized in Fig. 7). Statistical analyses of homologies between apolipoproteins A-I, A-IV, and E demonstrate conclusively that all three sequences diverged from a common ancestral gene. That apoA-IV largely composed of 22 amino acid amphipathic segments with alpha-helical potential suggests that it possesses the structural requirements for LCAT activation. Analysis of the apoB, E receptor-binding domain of human apoE3 has demonstrated that it evolved from an ancestral repeated sequence. Assuming that the genes for these proteins evolved as a result of a series of intra- and intergenic unequal crossovers, it is likely that their genetic loci were at one time linked. The repeated sequences of which these genes are composed have propagated themselves in an expansionary manner. Given this fact, the existence of other genes or pseudogenes based upon this repeated sequence motif is a distinct possibility.

Amino Acid Sequence↗
PubMed1987

Influence of family planning counseling in an adolescent clinic on sexual activity and contraceptive use.

We evaluated whether family planning counseling (FPC) in an adolescent clinic promoted the onset of sexual activity among the non-sexually active teens and/or increased contraceptive use among the sexually active teens. The FPC focused on the teens' establishing sexual values, the right to say "no," abstinence and alternate forms of intimacy, consequences of intercourse, and the various contraceptive methods. Data for one year were collected on the adolescents' first and subsequent visits to a medically oriented, municipal outpatient adolescent clinic. There were 383 teenagers who qualified for the study. Of these, 35% (134) reported premarital sexual activity. During the study period, 3% (8) of the 249 nonsexually active teens reported becoming sexually active. Among the 134 sexually active teens at clinic entry, 27% reported using a contraceptive method at their most recent sexual encounter. Among the 142 sexually active adolescents at the conclusion of the study, 76% reported contraceptive use at their most recent sexual encounter (p less than 0.001). We conclude that the provision of FPC to nonsexually active and sexually active teens does not appear to promote the onset of sexual activity significantly among the non-sexually active group, although it significantly increases contraceptive use among the sexually active group.

Adolescent↗
PubMed1986

Validation of a decision model for triaging hypertensive patients to alternate health education interventions.

The ability to assign patients to the most appropriate program of intervention would improve patient outcomes and reduce health care costs. This paper evaluates specific potentials of triaging patients into various combinations of health education treatments. Blood pressure improvement among hypertensive patients was measured and the associated treatment cost and savings were compared. Triaging rules were formed empirically from the relationship between patient characteristics selected before the study was conducted and their achieved blood pressure control within each combination of interventions. Patients randomly assigned to seven combinations of three interventions were studied in contrast to patients in a randomized control group. A combination of all three interventions was the most effective program for the undifferentiated (random) patient population, achieving a 49% increase over 18 months in patients with blood pressure under control. By triaging, 51-91% increases in patients with controlled blood pressure were achieved. Educational history of the patients which is a fairly reliable measure was the most efficient triaging variable, showing a 91% increase in patients with blood pressure under control and a relative cost saving of about 400%.

Adult↗
PubMed1980

A simple computerized system for plotting the locations of cells of specified sizes in a histological section.

A computerized plotting system is described which generates an outline of a histological section on an oscilloscope screen, and displays within its boundaries the positions of labeled neurons whose coordinates are sent to the computer electronically. Measured cell diameters can also be entered, allowing the computer to generate displays of the distributions of cells within specified size ranges. All data are saved by the computer, and any portion of a distribution may be examined oscilloscopically at several levels of magnification; moreover, three-dimensional displays may be generated wit appropriate programs.

Animals↗
PubMed1991

Optimization of high dose-rate cervix brachytherapy; Part I: Dose distribution.

Computer controlled high dose-rate (HDR) brachytherapy afterloading machines are equipped with a single, miniaturized, high activity Ir-192 source that can be rapidly moved in fine increments among several channels. Consequently, by appropriate programming of source dwell positions and times, the dose distribution can be optimized as desired. We have explored the optimization potential of this new technology for two applications: (a) cervix brachytherapy, and (b) transvaginal irradiation. Cervix brachytherapy with a gynecologic ring applicator was simulated by 48 sources of relative activities ranging from 0.17 to 1.00 that were equally distributed between the tandem and the ring. The results confirmed that the optimized distribution of physical doses are superior to those achievable with standard brachytherapy sources and applicators. For example, with five-point optimization, the relative dose-rate in the rectum was only 47% of that in point A; for standard application the dose rate was 47% higher. For transvaginal application 27 sources of relative activities between 0.07-0.79 were placed in the ring and a single source of unit strength in the tandem. Using dose distribution homogeneity as an optimization criterion, the results (+/- 2.5%) were again superior to those obtained for commonly used double ovoid (+/- 15%), linear cylinder (+/- 27%), or a "T" source (31%).

Brachytherapy↗
PubMed2003

Predictors of pre- and postoperative anxiety in emergency surgery patients.

OBJECTIVE: Emergency surgery is a highly stressful life event. Patients experience distressing anxiety both before and after surgery and this anxiety affects their recovery process. The aim of the present study is to examine variables related to pre- and postoperative anxiety in emergency surgery patients. METHODS: The sample consisted of 146 emergency surgery patients who had abdominal surgery in an emergency surgery clinic. The research instruments were administered before and after the surgery. State Anxiety Inventory (STAI-A State), Anxiety Specific to Surgery Questionnaire (ASSQ), a scale tapping fears and worries specific to surgery developed for the present study, Ways of Coping Inventory (WCI), and the Multidimensional Scale of Perceived Social Support (MSPSS) were administered. DATA ANALYSIS: Data were analyzed by using the appropriate programs of the Statistical Package for the Social Sciences (SPSS). RESULTS: There was a significant drop in anxiety from the pre- to the postoperative period. Female patients had higher preoperation anxiety than males. Females and males did not differ in anxiety at the postoperation period. Being female, waiting for primary suture for peptic ulcer perforation operation, and helplessness and self-blaming coping appeared as significant predictors of anxiety specific to surgery. Being female and awaiting for primary suture for peptic ulcer perforation were significant predictors of preoperative state anxiety. Finally, years of education were negatively and use of active coping was positively related to postoperative state anxiety. CONCLUSION: Patient sociodemographic and psychological characteristics and type of surgery need to be considered for identifying patients at risk of experiencing anxiety both before and after surgery and psychological support and clinical management needs to be tailored to the needs of the patients to alleviate their anxiety.

Adaptation, Psychological↗