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This introductory chapter lays the groundwork for the in-depth examination of special populations that follows. Drs. Frumkin and Pransky discuss what makes a population special, health disparities over the generations, and the evolving recognition of special populations in occupational health.
There is a renewed interest in the study of the cerebral hemispheric specialization given its physiological, physiopathological, clinical and educational relevancy. According to this, a stimulus is better processed in one of the cerebral hemispheres. The visual dichotic stimulation allows to present a stimulus selectively to one of the hemispheres, and this was used in the present study for the measurement of the reaction time (TR) and for the establishment of its correlation with an objective and validated measure of the cerebral hemispheric specialization. Ninety eight persons with an average age of 22.2 +/- 0.7 (X +/- EE) years were studied by means of the Oldfield protocol for the determination of the Cerebral Hemispheric Lateralization Index (IL). Additionally, the age, the sex and the date of last menstruation in the case of females, were registered. The dichotic stimulation and the determination of the visual TR was accomplished by computer with a time resolution of 100 microseconds. The stimulus consisted of the random presentation of a white square on a black background in a computer monitor, to which the subject had to respond by pressing a key with his best hand. The reaction time was registered 10 times in each visual field for a total of 20 records per eye. The IL of the sample was predominantly right (66.32 +/- 4.64), and significantly smaller in males than in females (p < 0.05). The TR to stimuli in the left visual field was significantly greater (p < 0.05) than in the right visual field for both eyes. When analyzing the global results of each cerebral hemisphere, a TR significantly smaller for the left hemisphere (304.33 +/- 4.1 ms) than for the right (312.35 +/- 4.5 ms, p < 0.05) was observed. These results suggest that the cerebral hemispheric specialization, expressed as a smaller response time, cannot alone be only the product of a better intrinsic hemispheric processing of the information, but also of the anatomical relationships of the proximity of the hemisphere that receives the stimulus and the center or area that will generate the response, as is the case of the motor center located in the left hemisphere in the immense majority of the right-handed subjects in the sample and in the general population.
The work load analysis for oral care in special nursing homes. Dental hygienists undertook oral care of 100 person who were confined to special nursing homes in Aichi prefecture, Japan. The time required, the physical load, the psychological burden were analysed. The results were summarized as follows; 1) Oral care by dental hygienist was incorporated as one of the 59 care tasks given in special nursing. 2) The working time for required oral care was 25.7 minutes per resident on an average. 3) In general, speaking to the elderly, recording on an assessment card, and observing conditions were undertaken most frequently. In oral care, tooth cleaning, gargling, cleaning of dentures, wiping of the mouth and advising those caring for the elderly, was performed most frequently. 4) In general, time taken for advising those caring for the elderly, report to the home dentistry, advising the elderly, recording, and evaluation was most common. In oral care by a dental hygienist, tooth cleaning, cleaning of the dentures, cleaning the mouth, gargling, prevention of dryness of the mouth were performed most frequently. 5) In physical activity, raising the person, moving him from the wheelchair to the bed and helping him to lie down were most frequent. In oral care by a dental hygienist, wiping the mouth, inserting dentures, tooth cleaning, cleaning the mouth and removing dentures were most common. 6) The psychological burden when lifting the person, moving him from the bed to the wheelchair and helping him to lie down was the greatest. In burden involving oral care by a dental hygienist, tooth cleaning, removing dentures, inserting dentures and cleaning the mouth were the greatest.
OBJECTIVES: This study sought to describe the motivation, experience and attitude change of 21 undergraduate medical students who chose a special study module in complementary therapy (CT). DESIGN: Survey; self-administered questionnaire before and after the module. SETTING: Second year medical students' course special study module in CT concentrating on homeopathy at The University of Birmingham Medical School, UK. RESULTS: Twenty questionnaires were completed at each time point with 19 sets of paired data. Students saw the module as offering a rare opportunity to examine and evaluate non-orthodox therapies. Eleven students had personal experience of a CT prior to the module, but there was a wide range of student attitudes from 'scepticism' to 'acceptance'. Students tended to rate the efficacy of CT as a whole, and homeopathy in isolation, similarly (P = 0.005). This trend was less marked at the end (P = 0.077). On both occasions CT was rated higher. Individual student's ratings moved in both directions. Twelve students considered learning and practising a CT, most commonly acupuncture. CONCLUSIONS: The evolution of UK undergraduate medical curricula has begun to incorporate non-core components through special study modules. The Birmingham CT module was popular and attracted students with a range of initial attitudes. We have demonstrated that it allowed a process of discernment about the value and role of CT within the established medical system whilst maintaining heterogeneity of opinion.
This study examines the effects of stress on hemispheric specialization and callosal transfer. Previous research suggests that the two cerebral hemispheres are asymmetric in their regulation of and response to stress. Further, studies have suggested that the activity of the corpus callosum may also be affected by stress. A group of 28 participants completed the Spielberger State-Trait Anxiety Inventory and performed a bilateral Stroop task. The bilateral Stroop task contains separate conditions which measure both hemispheric specialization and callosal transfer. A significant correlation was found between state anxiety and our measure of callosal transfer. Specifically, those individuals with greater state anxiety experience more efficient callosal transfer than did those with lower state anxiety. We conclude that state anxiety enhances callosal transfer without affecting hemispheric specialization.
The utiltiy of the Adaptive Behavior Scale in the special-education placement of 126 institutionalized mentally retarded children and adolescents was examined. An investigation of relationships among Adaptive Behavior Scale (Part 1) scores, Wide Range Achievement Test scores, and IQ scores revealed a significant relationship between Adaptive Behavior Scale scores as well as between IQ scores and achievement test scores. Adaptive Behavior Scale and IQ were the most effective scores in providing significant discrimination between the special-education training levels. Adaptive Behavior Scale subdomain percentage scores were discussed as criteria for a computer-assisted placement of mentally retarded students in a special-education program.
Special techniques for the endoscopic biopsy include both immunologic (IHC) and molecular approaches (ISH, PCR). Both approaches have been adapted to foster additional diagnostic power with little or no additional work by the endoscopist. The techniques take advantage of tissue-specific antigens, unique markers in infectious diseases, and unique nucleic acid sequences present in some malignancies. From these advantages, benign conditions may be more easily distinguished from malignant ones, the causes of some infectious diseases can be confirmed, and clinically relevant classification of malignancies can be made. Some special techniques have added difficulties, such as fastidious requirements for some IHC or Southern blotting. At UCLA, approaches with the least technical challenges are those in practice for endoscopic biopsy. Lastly, the information gleaned from special techniques requires endoscopic and histopathologic context for accurate interpretation.
Presented is a brief overview of basic principles and notions of geometric morphometrics, a new approach to quantitative analysis of shape variations. This approach is applied to analysis of variation of the skull shape in the sample of 18 muroid genera belonging to the families Cricetidae, Arvicolidae and Gerbillidae. The skull shape is described by landmarks, and skulls are compared by resistant fit and superimposition methods. Under consideration is relation of skull shape to the trophic specialization, to family belonging, and to body size. Axial skull reveals more conspicuous relation to each of the factor analyzed as compared to mandible. Zygomatic region and tooth raw are most differentiable, while change of auditory bulla is of secondary effect. Transition from omnivorous through granivorous to grass-eating specialization involves the same trend in each of the family studied in the case of axial skull but not of mandible. Most dependent of trophic specialization appeared to be shape of axial skull rather then of mandible. Arvicolines are most specific in respect to the skull shape. Shape to size relation, although rather slight, also involves the same zygomatic-dental region. The results obtained indicate probably that geometric morphometrics does reveal variations in the skull shape that are free of the size effect.
In a systematic search of the literature 19 clinical trials investigating the effects of tinnitus treatment with Ginkgo biloba special extract EGb 761 were identified and evaluated. The results of eight controlled studies on tinnitus due to cerebrovascular insufficiency or labyrinthine disorders of varying genesis for the most part show a statistically significant superiority of treatment with the Ginkgo biloba special extract EGb 761 as compared with placebo or reference drugs applied of periods of one to three months. Open studies, too, some involving large numbers of patients, revealed appreciable improvements under ginkgo treatment. Therapeutic success was not directly correlated with either the genesis or the duration of tinnitus. However, investigations of prognostic factors revealed that short-standing disorders have a better prognosis, so that better results can be expected from early-onset treatment. The tolerability of Ginkgo biloba special extract EGb 761 was excellent, and in this respect the controlled clinical trials revealed little difference between drug-treated and control groups.
Pressure sores are a major challenge for healthcare systems. Patients admitted to intensive care units are an important risk group for pressure sores. Systematic use of a protocol employing special surfaces to manage pressure is a basic measure for preventing pressure sores in institutionalized patients. In a study carried out in the Intensive Care Unit of the Hospital of Terrassa (Spain), the incidence of pressure sores before and after introducing a prevention protocol that included the systematic use of special surfaces to manage pressure was compared. The incidence of pressure sores in patients admitted in 1998 and 1999 was studied. Sore locations were recorded. The results of three periods were examined: before introducing the protocol (6.4% incidence), after introducing a protocol (1.1%), and after use of the protocol was consolidated (0%). The results of the study suggest that the systematic use of special surfaces to manage pressure, in accordance with a prevention protocol, is a basic measure for reducing the incidence of pressure sores in patients admitted to intensive care units.
When discussing the treatment of epilepsy, targeted populations need to be defined. Three patient groups, children, the elderly, and women, are considered "special" because of metabolic and physical differences that require particular care during treatment of this disease. Treatment options vary significantly among these populations. Metabolic differences in very young and elderly patients require close attention by the prescribing physician. Rates of metabolism in children may be much faster than in nonelderly adults, requiring dosing adjustments to ensure enough medication is used to control seizures. Additional concerns with treating children include their increased sensitivity to toxic effects. Elderly patients may have slower metabolic rates because of decreased renal or hepatic function, and thus these patients can easily be overdosed as toxic drug levels build when clearance is reduced. Many elderly patients also may have concomitant illnesses that require other chronic medications. The potential for drug interactions is very high among this population. Women are considered a special population because of issues related to contraception, childbirth, and breast-feeding. Some antiepileptic medications are known to reduce the efficacy of oral contraceptives, and no medication has been proven safe for pregnant women. The pharmacokinetic profiles of many new generation antiepileptic medications may be advantageous to these specialized populations by creating fewer adverse effects, cleaner metabolism, and the reduced risk for drug interactions and teratogenicity.
By history of special medical disciplines, it refers to history of many subjects in special medicine, basic medicine, clinical medicine, and preventive medicine. Being an important field in the research of medical history, it made its first appearance around 1911. For the period beginning from 1930's-1960's, it passes through 3 stages, viz. the beginning, the flourishing and the profound development. The first period includes the publication of over 400 papers, the 2nd period, over 440 articles, and that in the 3rd period, over 1300 papers. It has been estimated that over one hundred journals and newspapers published articles in this special field.
In 1994 the government of Puerto Rico adopted a capitated managed health care system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special health care needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special health care needs in capitated managed health care programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special health care needs under a capitated managed health care system.
Children with an autistic disorder may need more dental care and may also be more difficult to treat than healthy children. This study compared oral health in autistic and healthy children. Also explored was the dental management of autistic children within the non-specialized Public Dental Service. The study was designed as a case-control study with all cases of autistic disorders aged 3-19 years identified within a primary care area in southwest Sweden. One dentist did a clinical investigation of cases and one control per case. The patients, or their parents, answered a questionnaire. 28 patients were identified and 20 (71%) agreed to participate in the study. Cases and controls had a similar prevalence of fillings, caries, gingivitis and degree of oral hygiene. However, the need of orthodontic treatment seemed to be greater among the autistic children. According to a standardised assessment, autistic children were less able to cooperate in the dental treatment. Approximately 30% of the cases had occasionally been subjected to specialized dental care. The results of this study indicate that the care provided to autistic children within the non-specialized Public Dental Service is satisfactory, provided that there is access to a paediatric dentist when necessary.
In order to investigate the relation between the immediate early gene induction in neurons and neuronal specialization in respect to functional systems of newly formed behavior, the neuronal expression of Fos transcription factor in rat brain was studied in animals of learning group and home cage control group. Animals of the learning group acquired a new behavior of pressing a pedal. Fos-positive neurons were counted in the retrosplenial area of cingulate cortex and anterolateral area of motor cortex, i.e., the two brain regions that differ in the number of neurons showing specific activity during this behavior. In the home cage control animals the number of Fos-positive neurons was low and no difference was found between the two brain regions. In the animals of the learning group the number of Fos-positive neurons was significantly higher in the cingulate cortex characterized by the greater number of neurons specialized in relation to the system of new behavior. These findings suggest that the c-Fox expression can indicate the processes of neuronal specialization.
OBJECTIVE: Evaluation of dental behaviour of anxious children after treatment at a Special Dental Care Centre. DESIGN: Retrospective, descriptive study. SETTING: Dutch Special Dental Care Centre (SBT). METHODS: A representative sample of parents was interviewed 1-2 years after their child's treatment at the centre about their present behaviour with respect to the home dentist. RESULTS: Results were analyzed using Analysis of Variance. Results indicate that within 1-2 years more than 90% of the children visited a home dentist, 80% of them had to be treated curatively and 60% of the treatment was performed using local anaesthesia. Retrospectively, the parents report a decrease of their child's dental anxiety, when leaving the SBT. The level of anxiety is unchanged after 1-2 years visiting a home dentist. For the children there was a significant relation between dental anxiety as reported by the parents and not visiting a home dentist. The high prevalence of curative treatment might indicate that children in this group belong to a caries risk group and might need extra preventive attention. CONCLUSIONS: After the initial treatment at the special dental care centre most children return to their home dentist. The children in this group referred for dental anxiety, belong to a caries risk group and might need extra preventive attention.
BACKGROUND/AIMS: Specialized intestinal metaplasia around the esophagogastric junction is considered to be premalignant. The aim of this study was to examine prospectively the prevalence of metaplasia and to correlate its presence with clinical, endoscopic and histological findings. METHODOLOGY: In 101 symptomatic patients (40 women, 61 men; mean age: 55 yr, range: 20-79 yr), biopsies were taken from gastric type mucosa just distal to the esophagogastric junction. They were stained with hematoxylin and eosin and alcian blue-periodic acid Schiff for the detection of specialized intestinal metaplasia and inflammation of the cardiac mucosa (carditis) and with Warthin-Starry for H. pylori presence. RESULTS: Metaplasia was detected in 27 patients (26.7%). Multiple logistic regression analysis revealed that metaplasia was associated significantly with age (odds ratio, 2.8; 95% confidence interval, 1.2-6.6), endoscopic suspicion of short segment Barrett's esophagus (odds ratio, 3.6; 95% confidence interval 2.2-6.9), detection of H. pylori (odds ratio, 2.8; 95% confidence interval, 1.1-7) and presence of carditis (odds ratio, 6.4; 95% confidence interval, 2.8-16.8). CONCLUSIONS: The prevalence of specialized intestinal metaplasia around the esophagogastric junction is high in symptomatic patients. Age, endoscopic evidence of short segment Barrett's esophagus and histological presence of H. pylori and carditis are independent risk factors associated with its presence.
The contemporary role and tasks of hygienic-epidemiological service are the outcome of the significant social, demographic, economic and health changes as a result of general social development. Natural phenomena such as elemental catastrophies, pollution of human environment, permanent threat of breaking out war at different places, all these set special tasks and determine the role of hygienic-epidemiological service. The contemporary role of the hygienic-epidemiological service is to provide scientific approach to the efficient solving of topical hygienic-epidemiological problems originated in newly-made ecological conditions, disturbed balance in nature, and also in changes of social structure of population. The tasks of the hygienic-epidemiological service are classified according to the role and purpose of each institution and according to the territory where the institution is situated, all these depending on situation (regular or special). In regular situation they have the tasks which are concerned with protection of the living environment and they include prevention of the mass deseases, contagious and other. In special situation they are concerned with catastrophies such as floods, earthquakes, breaking out of grow epidemics, occurence of quarantine diseases and other, and their aim is to prevent or at least to lessen the consequences caused by these catastrophies.