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[Epidemiological study of psychiatric disorders under a social security system (Institute of Social Security and Services for Government Workers)].

The present study, fourth in the national literature about general psychiatric epidemiology, refers the experience of a social security system through the study of a sample obtained in a year of work of an important neurologic and psychiatric clinic of this system, studying relevant characteristics of 1 054 subjects in a total 7 102 acute and chronic psychiatric patients, showing a prevalence of 180 per 100 000 habitants. We found 36 different psychiatric disorders, most of them psychoneurotic in ambulatory patients and psychotic forms in hospitalized. The last ones made the 0.022% of the total sample. The biggest frecuency is made by young adults with moderate predominance of females than males. The sample is formed near the 10% by patients of 26 states of Mexican Republic. The period of major frecuency are the months of vacations of government workers, most of them of Public Education Secretary (Secretaría de Educación Pública). We comment some epidemiological articles of Mexican medical literature concerning psychiatric disorders and some socioeconomic and cultural characteristics of mental pathology in our country.

Adolescent↗

Hospitalist staffing requirements.

CONTEXT: The use of hospitalists--physicians who spend a substantial portion of their time providing in-hospital care to the patients of primary care physicians--has been proposed as a way to decrease costs and increase the quality of inpatient care. COUNT: Number of full-time hospitalists. CALCULATIONS: Average daily census = annual admissions x length of stay divided by 365. Number of hospitalists = (average daily census divided by patients per hospitalist) + 1 extra hospitalist for night coverage. DATA SOURCES: The average number of patients per hospitalist was obtained from a National Association of Inpatient Physicians membership survey. A low estimate of 10 patients per hospitalist was used to account for the extra manpower needed for coverage during vacations and other time off. RESULTS: A hospital with 3000 admissions per year and an average length of stay of 5 days would have an average daily census of 41 patients and would need 5 full-time hospitalists. Hospitals with a lower patient volume would need fewer hospitalists and would probably need to find persons other than hospitalists to cover some nights and weekends. CONCLUSIONS: Simple calculations based on hospital admissions and length of stay can estimate the number of hospitalists required for adequate staffing. Requirements will vary with the hospitalists' workload; the patient case complexity; and the duties other than inpatient care that are required of hospitalists, such as consultations, skilled nursing facility coverage, quality improvement work, teaching, and research.

Health Services Research↗

Factors associated with treatment-related stressors in hemodialysis patients.

The objectives of this study were to describe the treatment-related stressors of incenter hemodialysis patients, to identify relationships between stressors and selected demographic and illness variables, and to identify changes in stressors over time. Data were collected at two points in time, 3 months apart. The data were obtained from 86 patients in 2 inner-city midwest dialysis units. Structured interviews were conducted using one open-ended question and the Hemodialysis Stressor Scale. The greatest stressors were fluid limitations, the length of dialysis, and vacation limitations. There was a consistent trend for almost all stressors to become more intense over time, with some specific stressors increasing significantly. Patients new to dialysis and those with more education had relatively more stressors. An important serendipitous finding was that some treatment-related stressors were not troublesome because subjects chose not to follow certain treatment recommendations. In-depth evaluation in relation to individual stressors is required before adequate individual intervention strategies can be developed. Nurses need to be educated about the factors that are stressful to patients, so they can support them appropriately.

Activities of Daily Living↗

Limitations of occupational air contaminant standards, as exemplified by the neurotoxin N-hexane.

Available industry guidelines and federal standards have failed to fully protect workers from chemical toxicity: none exist for most chemicals, many are biased toward what can easily be achieved, and many were developed long after health consequences became evident. Limitations of occupational air contaminant standards in the United States are well illustrated by standard-setting for the neurotoxin n-hexane. In the 1940s, the American Conference of Governmental Industrial Hygienists (ACGIH) first promulgated industrial guidelines known as "threshold limit values" (TLVs), including an 8-hour time-weighted average of 500 ppm for inspired n-hexane. Despite subsequent recognition of the neurotoxicity of n-hexane with industrial outbreaks of polyneuropathy beginning in the 1960s, the TLV for n-hexane remained unchanged until 1976 when a value of 100 ppm was adopted. Because a growing number of clinical reports have identified clinical and subclinical neurotoxicity from n-hexane near, at, and below the current time-weighted average TLV of 50 ppm, even this level is too high to protect all workers. In part due to procedural and political constraints, the Occupational Safety and Health Administration (OSHA) has independently developed only a small number of exposure standards in the past 25 years, and has been incapable of providing needed revisions for existing standards. Most OSHA standards--including those for n-hexane--were adopted in 1971 from the 1968 ACGIH TLVs and have never been revised. From 1971 to 1989 the OSHA permissible exposure level (PEL) for n-hexane remained at 500 ppm, 5-10 times as great as other contemporary standards. To help correct its regulatory backlong, OSHA promulgated 375 new or revised PELs in 1989--including a new standard of 50 ppm for n-hexane--but all of these were vacated by the 11th U.S. Court of Appeals in 1992. As a result, the current OSHA PEL for n-hexane remains at the 500 ppm level adopted in 1971, which even then was too high based upon available scientific evidence. New information over this long period, including that obtained from industrial outbreaks of disease due to chemical exposures, has not been incorporated into revised federal standards.

Adhesives↗

[A new case of subcutaneous dirofilariasis].

Authors describe another case of subcutaneous dirofilariasis due to Dirofilaria (Nochtiella) repens in France. A 26-year-old woman was infected while on vacation in Cap d'Agde on the Mediterranean coast. The patient presented with a subcutaneous nodule in the right subclavicular region. Examination of the nodule after surgical excision revealed the presence of a worm identified as an immature female Dirofilaria repens. Dirofilariasis is a rare anthroponotic disease encountered only in the Old World, particularly in Southeastern France including Corsica which has the second highest number of reported cases after Italy. Since man is a dead-end for the parasite, Dirofilaria repens does not mature and hence most human infections present as isolated subcutaneous nodules. Nodules are usually located in areas exposed to bites by the dipteres, i.e. the face (46 p. 100 of cases reported in the world) and the periocular and palpebral region (30 p. 100). Diagnosis is based mainly on morphological examination of the worm after surgical excision. However promising results in diagnosis of ocular and visceral forms of Dirofilaria repens and understanding of helminthiasis have been achieved thanks to progress in immunological techniques, i.e., ELISA and western blot, and DNA analysis based on polymerase chain reaction.

Adult↗

[The gift of breast feeding--the practice of breast feeding in Israel].

Breast milk is the optimal food for infant growth and development, the prevention of infectious diseases and mother-child bonding. From the economic perspective, breastfeeding is cost-effective both for the family and society as a whole. The Israeli Ministry of Health encourages breastfeeding as the exclusive source of nutrition for infants in the first 4-6 months of life, with gradual addition of complementary foods thereafter. The promotion of breastfeeding in Israel requires comprehensive national activity with involvement of all the stakeholders. This includes implementation of the International Code of Marketing of Breast Milk Substitutes and joining the international "Baby Friendly Hospitals" project. Knowledge of breastfeeding should be spread, health professionals should be encouraged to become agents of change, support by breast counselors should be encouraged, post-delivery vacations from work should be prolonged and empowerment of women implemented.

Breast Feeding↗

[Q fever: not just in sheep].

Four patients, a woman aged 41 years and 3 men aged 12, 47 and 44 years, developed high fever after returning from a farm vacation in the Ardèche (France). They also suffered from severe headache, a painful tightness of the chest, abdominal pain or myalgia. Other symptoms were shivers, tiredness and a cough. While physical examination revealed few abnormalities, the chest X-ray in 3 patients showed an atypical pneumonia. One of these patients developed dural venous sinus thrombosis with increased intraspinal pressure. This patient also showed signs of a slight hepatitis. Serological investigation revealed that all 4 patients were suffering from acute Q fever, a zoonosis caused by the Coxiella burnetii bacterium. All 4 had been present at lambing and sheep-shearing. The patients with pneumonia were treated with antibiotics. All 4 patients recovered well. It is known that animal birth products in particular can contain large numbers of bacteria and therefore be highly infectious.

Acute Disease↗

Intensified physiotherapy improves fitness to fly in cystic fibrosis patients.

OBJECTIVES: The life expectancy for patients with cystic fibrosis has risen constantly within the last 10 years to an average age over 20 years in western countries. However, most of these patients are partially respiratory insufficient. Frequently their physicians must decide whether it is acceptable to expose them to reduced air pressure on board of an aeroplane during long distance flights or how their fitness to fly can be improved prior to their annual vacation. We investigated the effect of intensified daily physiotherapy -carried out during a four weeks stay on Gran Canaria, Spain- on lung-function parameters, oxygen saturation and saliva neopterin as marker for ongoing inflammation in the respiratory tract. METHODS: 10 out of 12 patients (age 19 34 years, mean 28.6 years) were investigated two weeks prior and two weeks after their trip to the Canaries, Spain. Lung function on ground level and during flights to and from the island, oxygen saturation and saliva-flow adjusted neopterin in saliva were measured. RESULTS: Over the entire group vital capacity (VC) improved significantly from 2.89 l (range 1.37 3.95) to 3.36 l (range 1.23 5.24). Intrathoracic gas volume as a sign for pulmonary hyperinflation- declined slightly from 3.79 l (range 2.06 6.17) to 3.48 l (range 2. 18 5.85). The oxygen saturation increased from 89.5% (range 79 - 92%) during the flight to the Canaries to 94% (range 82 - 96%) during the return flight. Saliva neopterin dropped from 0.8 pmol/min. (range 0.2 6.8 pmol/min) to 0.6 ( range 0.1 2.6 pmol/min) pointing to diminished inflammation in the respiratory tract. CONCLUSION: Our results indicate that fitness to fly can be improved by intense physiotherapy as shown by improvement of vital capacity and oxygen saturation during flight. The influence of an additional climate change on the improvement of lung function in CF-patients needs further evaluation.

Adaptation, Physiological↗

Leadership progression in schools of allied health.

The purpose of this study was to determine the number of future vacancies in the lead administrator positions (i.e., dean or director) in schools and units of allied health academic programs and the potential pool of candidates for the positions. The survey was mailed to the deans or directors of the 100 institutional members of the Association of Schools of Allied Health Professions (ASAHP). The response rate was 80%. Of the respondents, 58% reported intentions to vacate their positions in the next decade; another 28% reported being unsure of their plans. Retirement was listed as the primary reason (76%). The respondents listed 239 qualified candidates for their positions, or 5.2 candidates per vacancy. The ASAHP's initiatives in leadership development appear to have prepared allied health education for leader succession.

Administrative Personnel↗

Pediatric travel consultation in an integrated clinic.

BACKGROUND: In May 1997, a pediatric travel service was created within a larger integrated University-County Health Department international travel clinic. The purpose of the service was to further enhance the travel advice and care provided to children and their parents or guardians. The current study was designed to describe the care of children in this setting and to compare the care of children seen in the Pediatric Travel Service with that of children seen by other providers. METHODS: All pediatric patients (defined as individuals < or = 18 years of age) receiving care in the travel clinic were considered candidates for inclusion in the analysis. Patients seen by the Pediatric Travel Service were compared to those seen by other staff members in the travel clinic (referred to as Regular Clinic). The following information was noted: basic demographic data, medical history including allergies, prior immunization records, intended place and duration of travel, and immunizations and medications prescribed at the time of visit. Travel advice covering water and food precautions, preventive measures against insect bites, injury prevention, malaria prevention, prevention of parasitic infections, and environmental-related problems was provided to all patients in both groups when necessary. RESULTS: Between May 1997 and December 1999, 287 pediatric age individuals were given pretravel care by the Pediatric Travel Service (median age, 6 years; range, 1 month-18 years). During the same time period, 722 pediatric age travelers (median age, 14 years; range, 8 months-18 years) were evaluated in the Regular Clinic by other staff members. Travel destinations most commonly traveled by both groups in descending order were: Africa, Central America and Mexico, South America, and Southeast Asia. When compared to travelers seen in the Regular Clinic, individuals in the Pediatric Travel Service group were more likely to travel for humanitarian work, and for parental work relocation. Persons in the Regular Clinic were more likely to travel to Mexico and Central America. They were also more likely to travel on vacation and for missionary work or study. Hepatitis B and tetanus-diphtheria booster vaccinations were given more frequently to travelers seen in the Regular Clinic. Also, ciprofloxacin and antimotility agents were more commonly prescribed in this group. No differences were noted in the duration of travel or in the time interval between clinic visit and departure. CONCLUSION: While general travel advice was considered to be similar in both clinic groups, some differences were observed in the frequency of administration of certain vaccines and prescriptions of medications. These differences were likely due to a difference in age in the two study groups. The high volume and success of the clinic suggest that integrated pediatric and adult travel services in a coordinated setting can be effective.

Adolescent↗

Falling from the top: the fired physician executive.

Today's health care market is volatile, and the job of a physician executive is becoming more risky. Recognizing signs of trouble and taking immediate action is essential. Ten early warning signs that you could be fired are: (1) Net profits dip unexpectedly; (2) investment income can't cover operating losses; (3) bond rating is downgraded; (4) revenues are not rising as fast as costs; (5) senior executives leave the team; (6) wage increases don't improve nursing vacancy rate; (7) unions begin whisper campaign; (8) medical staff elect an SOB; (9) hospital is slapped with a costly lawsuit; and (10) recruiters call to check on your status. Physician executives are quickly learning what it takes to overcome tough challenges and prevent premature job termination: Communication; no-surprise performance; continuous monitoring of key indicators; openness and plain talk; and no-more-business-as-usual attitude. What can you do to make your job loss as painless as possible? (1) Negotiate a contract upfront; (2) don't lose your temper; (3) ask for your wish list quickly; (4) be reluctant to sue your former employer; (5) tell your family as soon as possible; (6) take only a brief vacation; (7) consider a temporary assignment; (8) be prepared to be re-employed by your former employer; and (9) keep a positive attitude.

Career Mobility↗

[Substantiation of optimal education-training load for preschool children 3-4 years of age].

The study was undertaken to make a sanitary regulation of educational and training load in junior and middle group preschool children of general children's educational institutions (CEIs). Experts' assessment was chosen to study the impact of regular educational and training load on the child's functional status. The experts were tutors and methodologists of CEIs (n = 186). The study has revealed the optimum number of lessons a day and a week, their duration and ratio in the weekly curriculum of lessons that are different in nature and showed it necessary to determine a vacation in the middle of a school year and to reduce the number of children in a group.

Child Welfare↗

Salaries and benefits of dental hygienists in Tennessee.

Salaries and benefits are a major concern for dental hygienists and their employers. In 1998, the University of Tennessee Dental Hygiene Department conducted a survey of dental hygienists licensed to practice in Tennessee. Objectives included (1) to determine the current salary range and benefits of practicing dental hygienists, (2) to determine the factors which influence salaries and benefits, and (3) to compare the salaries and benefits of dental hygienists across the state. Results revealed an average compensation of $175.00 per day. While most full-time dental hygienists receive paid vacation, only 33 percent receive health care benefits. There were various factors influencing salaries and benefits, including the method of compensation, region of the state in which one practices, years of experience, and ethnic background.

Adult↗

Outbreak of acute respiratory febrile illness among college students--Acapulco, Mexico, March 2001.

On March 30, 2001, CDC was notified by Pennsylvania Department of Health (PDH) of an acute respiratory febrile illness in 44 students from two colleges who traveled to Acapulco, Mexico, for spring break vacation during March 3-18. Within 7-14 days of their return from Acapulco, 21 students presented to health-care providers with illness characterized by fever, chills, dry cough, chest pain, and headache. Two students were hospitalized. On the basis of clinical symptoms and chest radiographs that revealed bilateral, nodular patchy infiltrates, acute pulmonary histoplasmosis was the suspected illness. While in Acapulco, most of the students stayed at the Calinda Beach Hotel and participated in group activities at other recreational locations.

Adult↗

[Model to predict staffing for anesthesiology and post-anesthesia intensive care units and pain clinics].

Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.

Anesthesiology↗

Memory Clinics in Switzerland. Collaborative Group of Swiss Memory Clinics.

Currently, eleven Memory Clinics (MC) in Switzerland offer their services to patients, caregivers and family doctors. Their primary goal is the early diagnosis and management of dementia in elderly outpatients. Special emphasis is put on the detection of reversible causes of dementing disorders. Diagnoses and medical, pharmacological, neuropsychological and social treatment recommendations are established in a multidisciplinary consensus conference and communicated back to the referring physicians. The psychosocial therapies and supportive activities include counseling, memory training for patients, neuropsychological rehabilitation, caregiver groups, relaxation and biofeedback training, day care centers, Alzheimer's Tanzcafé, and special vacations for dementia patients. These activities vary from MC to MC according to the availability of resources. Research activities are an integral part of all MCs and range from the attempt to identify preclinical markers of Alzheimer's disease to studies of neuropathological correlates of cognitive disturbances. Moreover, patients are encouraged to participate in studies investigating new medications. MCs play an important role in the education and training of health care professionals and in raising awareness and support in the general population.

Aged↗

[Zoeros Pasha's report presented to the Sultinate on his return from Paris].

The Ottoman Empire dispatched a committee consisting of Zoeros Pasha, the president, Dr. Hüseyin remzi and veterinarian Hüseyin Hüsnü, who were members sent to learn how the method of the vaccination of rabies was practiced in Paris in 1886. Zoeros Pasha relates their studies in Paris, as well as his idea on the novelties he observed there and comments on the advantages of them in case of application in the Empire, in his report dated December 29th of 1886, prepared on his return from Paris. Zoeros Pasha and Hüseyin Hsnü Bey learned the vaccination practice, attending Pasteur's laboratory. Zoeros Pasha studied bacteriology for three months and Hüseyin Remzi attended the laboratory of "Jardin des Plantes" in order to do some zoological researches. When Pasteur went on vacation, Zoeros Pasha provided for Hüsnü Bey to attend the Veterinary School of Paris and directed his attention to the anthrax vaccination found by Pasteur. Hüseyin Hsnü Bey and Dr. Hüseyin Remzi Bey composed a book based on their translations on the subject Zoeros Pasha also mentions in his report the following topics on which he says he could report, if desired: 1. New methods of treatment applied for heart and lung diseases. 2. The most effective prophylactic methods and sanitary precautions on the epidemic and infectious diseases. 3. Improvement planned for the Imperial School of Medicine. 4. Use of anatomy in finding out criminals, in order to help the police forces.

Bacteriology↗

Cardiological monitoring of sailors via offshore Internet connection.

BACKGROUND: Sailing is becoming increasingly popular as a form of holiday recreation. The purpose of the present study was to profile the heart rate characteristics of non-professional crew members on a Mediterranean sailboat trip. Additionally, the practicability of transferring electronic data via the Internet while sailing offshore was also studied. METHODS: Seven healthy male non-professional crew members responsible for steering and navigating the boat during the observation period were studied using continuous electrocardiographic recording (Holter). Manually measured blood pressure, side effects and sailing data were taped half-hourly. RESULTS: While sailing we observed that the heart rate increased typically into the 120-170 beats/min range, mean arterial pressure remained stable between 80-90 mmHg. Heart rate changes and the incidence of supraventricular arrhythmias correlated with activity on board, boat speed and wind velocity. No subject showed ventricular arrhythmias during sailing. The minimal blood pressure changes correlated only with activity on board. CONCLUSIONS: All these results indicate that sailboating on vacation, even in a non-professional status, does not promote disease-relevant changes in heart rhythm on trips in mild to moderate seas. Additionally, we were able to demonstrate that the online transfer of electronic data via the Internet from a sailboat offshore is possible, easy and inexpensive.

Adult↗