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PubMed2005

Methods for epidemiological study of injuries to professional football players: developing the UEFA model.

A problem with epidemiological studies of football injuries is the inconsistent manner in which injury is defined and data are collected. Projects have been initiated to study the incidence and causes of injury in football, but there is no uniformly accepted reporting system. In this report, some common pitfalls encountered in the recording of injury are addressed, and practical guidelines for epidemiological studies are provided. An injury reporting system developed for the UEFA Football Safety Project for studies on professional footballers is used as a starting point for a general discussion on injury registration and compared with other existing reporting systems. The recording definition of injury may vary between studies depending on its purpose. A time loss injury definition is practical for all playing levels, and, as a minimum, results on time loss injuries should therefore always be reported separately to allow direct comparisons between studies. There is a need to agree on a uniform sports injury classification system with corresponding diagnostic criteria, as well as standardised return to play criteria after injury.

Athletic Injuries↗
PubMed1995

The Oxford growth study: a district growth surveillance programme 1988-1994.

OBJECTIVES: To develop a method of community based growth assessment. SETTING: Oxford District, United Kingdom. METHODS: A system of growth surveillance involving a community consultant paediatrician, a paediatric endocrinologist, a clinical auxologist, a project coordinator, and the many primary health care teams was started. Letters and meetings were arranged to introduce the programme to general practitioners and health visitors, emphasising the importance of growth assessment in normal child development. They were asked to measure all children as part of their routine developmental checks at 3 and 4.5 years of age. Community growth assessment clinics staffed by an experienced auxologist were established. Children whose heights were more than two standard deviation (SD) scores below the mean or whose height SD score decreased between the two ages were referred to the clinic. Any child whose height was more than 3 SD scores below the mean was referred directly to the paediatric endocrinologist. Those seen in the community clinics were followed up for a year and if their velocity was > 25th centile, karyotype normal, and bone age appropriately delayed, they were discharged to the general practitioner for further follow up. Any child with an annual velocity < 25th centile was referred to the endocrinologist. RESULTS: Of 20,338 children monitored, 260 (1.3%) had heights > -2 SD scores. Seventy six were lost to follow up, 35 were measuring errors, 69 were already seeing a paediatrician, leaving 80 children to be evaluated. Of these, 69 were "short normals" and 11 were newly identified diagnoses. CONCLUSIONS: This system of secondary referral keeps normal healthy children out of hospital, avoids unnecessary over-investigation, reduces travel and anxiety for families, avoids filling specialist clinics with normal children, and provides an inexpensive system of growth surveillance.

Analysis of Variance↗
PubMed2006

Epoxy resins in the construction industry.

Epoxy resins are used as coatings, adhesives, and in wood and concrete repair. However, epoxy resins can be highly irritating to the skin and are strong sensitizers. Some hardeners are carcinogenic. Based on the results of earlier Dutch studies, an international project on "best practices,"--Epoxy Code--with epoxy products was started. Partners were from Denmark, Germany, the Netherlands, and the UK. The "Code" deals with substitution, safe working procedures, safer tools, and skin protection. The feasibility of an internationally agreed "ranking system" for the health risks of epoxy products was studied. Such a ranking system should inform the user of the harmfulness of different epoxies and stimulate research on less harmful products by product developers.

Dermatitis, Allergic Contact↗
PubMed2002

Adult height after GH therapy in 188 Ullrich-Turner syndrome patients: results of the German IGLU Follow-up Study 2001.

OBJECTIVES: We aimed to evaluate the factors influencing true adult height (HT) after long-term (from 1987 to 2000) GH treatment in Ullrich-Turner syndrome (UTS) based on modalities conceived in the 1980s. DESIGN: Out of 347 near-adult (>16 Years) patients from 96 German centres, whose longitudinal growth was documented within KIGS (Pharmacia International Growth Database), 188 (45, X=59%; bone age >15 Years) were available for further anthropometric measurements. RESULTS: At a median GH dose of 0.88 (10th/90th percentiles: 0.47/1.06) IU/kg per week, a gain of 6.0 (-1.3/+13) cm above the projected adult height was recorded. Variables were recorded at GH start, after 1 Year GH, puberty onset, and last visit on GH therapy. At these visits, the median ages were 11.7, 12.7, 14.2, 16.6 and 18.7 Years; and median heights, 0.4, 1.1, 1.7, 1.7 and 1.3 SDS (UTS) respectively. Height gain (DeltaHT) after GH discontinuation was 1.5 cm. Total DeltaHT correlated (P<0.001) negatively with bone age and HT SDS at GH start, but positively with DeltaHT after the first Year, DeltaHT at puberty onset, and GH duration. Final HT correlated (P<0.001) positively with HT at GH start, first-Year DeltaHT, and HT at puberty onset. Body mass index increased slightly (P<0.05), with values at start and adult follow-up correlating highly (R=0.70, P<0.001). No major side effects of GH occurred. CONCLUSIONS: GH dosages conceived in the 1980s are safe but too low for most UTS patients. HT gain and height are determined by age and HT at GH start. Height gain during the first Year on GH is indicative of overall height gain. After spontaneous or induced puberty, little gain in height occurs.

Adolescent↗
PubMed1989

Sentinel Event Notification System for Occupational Risks (SENSOR): the concept.

Although many states have laws that require health providers to report cases of occupational illness and injury, most states do not maintain a comprehensive system that actively identifies and targets potential sources of case reports and then responds to such reports. NIOSH has developed a Sentinel Event Notification System for Occupational Risks (SENSOR) that uses targeted sources of sentinel providers to recognize and report selected occupational disorders to a state surveillance center. SENSOR is a cooperative state-federal effort designed to develop local capability for preventing selected occupational disorders. To demonstrate the feasibility of this approach, NIOSH initially funded seven SENSOR projects in 1987 and three additional projects in early 1988 (Table 1). Currently, these projects are in the preliminary stages of organization and start-up, with some having begun to receive case reports. As funds become available, NIOSH intends to gradually expand the scope of the program to include additional states over the next several years.

Humans↗
PubMed1995

Teaching of human anatomy: a role for computer animation.

Computer-assisted learning fulfils an important need for pictorial representation of the functions of organs and systems. The various computer techniques of animation and morphing provide promising horizons for medical educational technology. Image acquisition is one of the most resource-intensive components of animation sequence development. Images can be drawn as originals or can be copied/scanned from various sources. By standardizing the initial (starting) image to the particular/basic need of the teacher and projecting the end-point image by using a vector animation package, 'films' can be created to demonstrate any form of movement. In the Anatomy Department, Sultan Qaboos University in Muscat, computer-animated tutorials are being introduced to illustrate normal and abnormal functional anatomy. The heart and its valve mechanisms have been selected as a pilot study. The student response is very positive and the technique has great potential. Embryology animations showing the formation and growth of organs such as the brain and spinal cord are also being developed.

Anatomy↗
PubMed1992

Staff empowerment: a medical record department's preliminary experiences with continuous quality improvement.

After observing the results of continuous quality improvement, no one would argue against its value in the workplace. However, learning to apply the concepts requires change on everyone's part, and the challenge lies in effecting this change. Not everyone will want to work in this type of environment and, if the organization is truly committed to continuous quality improvement, those individuals may have to make hard decisions as to whether the organization is the right place for them to work. Certain skills are required for staff empowerment to be successful, and training in these skills is essential. The medical record department staff learned early in this process that, although the group possessed job skills, interaction and team skills were lacking. The Development Dimensions International program helped the managers and staff identify the weaknesses of the group and provided educational tools for improvement. The changes often are so subtle, the group does not realize anything has changed. It was not until recently, when the medical record department staff was requested by administration to identify department quality improvement projects, that the group looked back at where the process started and realized how different things are today from three years ago--now staff members lead team meetings, work-groups are redesigning their job processes, and teams update the rest of the department staff on its progress at department meetings. Everyone expressed a sense of pride and accomplishment that the group had indeed responded to the challenge. The experiences of the medical record department thus far clearly support empowerment of employees.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMedDate not supplied

[The reduction of the HIV vulnerability of women involved in the sex business in Ukraine through social mobilization and the creation of self-support networks].

The importance of making plans on projects and measures, aimed at the prevention of HIV infection and the social development of female sex workers (FSW) with due regard to observing the principles of human rights protection, is discussed. The materials and resolutions of the First International Conference "Social Development of HIV-Vulnerable Groups of Population", held of Kiev on December 26, 1998, are presented. The conference was attended by representatives of state and public organizations, specialists on the organization of the prevention of HIV and sexually transmitted diseases among FSW, lawyers, physicians and representatives of the HIV-vulnerable target group (FSW) from 7 Ukrainian cities and from Belarus. All these activities contributed to the implementation of the Project "FSW Network Initiative with NGOs" in 11 Ukrainian cities, starting from September 1999, with the support of UNAIDS. The possibility of the mobilization of FSW for organizing self-support groups with a view to protect their rights and to take themselves measures for HIV/AIDS prevention among FSW is shown.

Disease Susceptibility↗
PubMed2000

[Breast cancer mass screening in the Province of Liege. Results after 8 years].

Breast cancer mass screening by mobile units started in 1992 in the Province of Liège (Belgium). This project is developed for rural areas and interests all women between 40-69 years old not regularly X-rayed in traditional breast cancer diagnosis centers. Despite lots of efforts population participation is low (25%). Nevertheless, the experiment results are encouraging: in a series of 31,443 women, 213 cancers were diagnosed, corresponding to a rate of 6.9/1000, 75% of which are of good prognosis. After an 8 years experiment, it is hoped that the population concerned becomes more sensitive to this mass screening project and one should expect a better collaboration with the other actors in the field of breast diseases diagnosis.

Adult↗
PubMed2002

Cone neurite sprouting: an early onset abnormality of the cone photoreceptors in the retinal degeneration mouse.

PURPOSE: Mutations in many rod genes can cause inherited blinding neurodegeneration in the retina characterized by sequential death of rod and cone photoreceptors. This study was to examine the morphological changes of the cone photoreceptors in retinal degeneration (rd1) mice caused by rod-specific cGMP phosphodiesterase beta-subunit gene mutation and to gain insights into the early cellular events underlying the secondary cone death. METHODS: Transgenic mice that have their living cones labeled by the green fluorescent protein (GFP) transgene and carry the homozygous rd1 mutation were generated, and identified by PCR analysis of the mouse tail DNA and PCR coupled Dde I digestion. The morphology of cone cells in live and fixed retinas from developing and adult mice was examined with fluorescence and scanning laser confocal microscopy. Some fixed mouse retinas were also examined by immunocytochemical staining. Volume images from the confocal three-dimensional (3D) data sets were processed with IMARIS software for 3D view of the detailed cone cell morphology. RESULTS: The cone photoreceptors in the rd1 retinas exhibited a novel process of neurite sprouting, in addition to the general pathological changes of cone degeneration such as shortening and loss of cone outer and inner segments, and loss and death of the cones. The cones gave rise to prominent neurite outgrowth from their axons and synaptic pedicles as well. Most neurites had beaded varicosities along their length and some terminated as bulbous structures. Some cone pedicles showed abnormally elongating and branching processes. The degenerating cones were disorganized, and migrated into the inner nuclear layer. Some cone neurites extended horizontally and appeared to contact the rod bipolar cells, while others projected into the inner plexiform layer. The aberrant cone sprouting started from P8 when rod degeneration generally began, and became evident by P10. In contrast, this abnormal cone neurite sprouting was not observed in the examined control mice that did not carry the rd1 mutation. Double-labeling with cone cell-specific peanut agglutinin confirmed that the fluorescent cells expressing the GFP in the rd1 retinas were indeed the cone photoreceptors. CONCLUSIONS: Cone photoreceptors in the rd1 mice underwent a remarkable process of neurite sprouting that appeared to start before the onset of cone cell death and persisted throughout the course of cone degeneration. This novel process of cone neurite sprouting may be a part of the early cellular events leading to the cone photoreceptor death in retinal degeneration of the rd1 mice.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2002

Resources for development of training in public health and health managment in Eastern Europe: the Kaunas experience.

The aim of this paper is to review the resources and steps required for development and evaluation of training in public health and management of public health as experienced in Kaunas University of Medicine, Lithuania. The transition from Departments of Social Medicine and Hygiene to a Faculty of Public Health of international standards requires a process of adaptation and development of human resources more than physical facilities. After restoration of independence in 1990, rapid development of training in public health was started in Lithuania. Great support was provided by the international projects Baltic Rim Partnership for Public Health (BRIMHEALTH) and European Union Trans-European Mobility Scheme for University Students (TEMPUS). Undergraduate and postgraduate training programs were successfully implemented in the Faculty of Public Health, Kaunas University of Medicine. Lithuanian experience could serve as an example of success and pitfalls in training a critical mass of professionals who should act as powerful advocates for health, promoting analysis, continuity and success of public health interventions, and health care reforms in countries in transition.

Curriculum↗
PubMedDate not supplied

[Initiatives of the Rivista dell'infermiere].

Several research, reflection and work proposals had been published in Rivista dell'infermiere during the past 6 years, with the double aim of starting a dialogue with the reading public and activating research projects. Some of the proposals were carried out and published, some are still at proposal level. A list of proposals presented, divided according main subjects, are presented together with a request to readers to suggest which one Rivista dell'infermiere should develop in the next two years.

Education, Nursing↗
PubMedDate not supplied

The impact of tech aides in radiology.

As the staffing shortage continues to impact radiology departments and outpatient imaging centers, managers look for ways to solve staffing issues internally. Lehigh Valley Hospital and Health Network investigated the feasibility of adding a position of radiology tech aide. This proposal was driven by a desire to improve retention of staff, improve employee satisfaction and reduce turnover. A 6-month pilot program was conducted at the network's highest-volume facility. One tech aide underwent extensive training and eventually began performing some of the tasks identified in the analysis. Each area within radiology worked with an intern to identify each step in its work process. Each step identified led to the question, "What happens if?" The workflow process provided a detailed look a the number of steps required for a technologist to perform a study from start to finish. In May 2002, the administrator submitted a project proposal to management engineering to evaluate radiologic technologists' workloads and identify tasks that could be performed by a tech aide. Activity-Based Management (ABM)--a process that emphasizes activities over resources--was utilized to study work activities. The analysis identified the appropriate tasks and revealed that 5 FTEs were needed to assist the technologists in all areas of radiology. A workflow was completed for each area within radiology. Some areas identified bottlenecks, which caused delays in the process and some redundant work for the staff. Data were presented to the network administration. Staffing realities, labor pool availability within the existing network staff, and detailed task identifications also were provided. A total of 5 FTE tech aides were approved. The final program included in-depth tech-aide training; effective and open communication between management and technologists; and a collaborative, education-oriented relationship between technologists and tech aides.

Appointments and Schedules↗
PubMed2003

Congenital adrenal hyperplasia: should nationwide screening be implemented in Thailand?

A project to establish the Thailand National Neonatal Screening Program was started in 1996 with the objective of screening every newborn for congenital hypothyroidism and phenylketonuria. Over a million newborns were screened and over 430 abnormal cases were detected. A study was also conducted to determine the feasibility of including CAH screening in the program. The incidence of this disease has not yet been clearly determined. Since 1999, 58,563 newborns have been screened for CAH and 144 newborns with serum 17-OHP higher than 40 ng/mL were recalled for confirmatory tests. Of those, 68 were retested and 6 were found to have elevated 17-OHP levels. Two were confirmed with salt wasting CAH one month after birth, two others were diagnosed with another disease that caused electrolyte imbalance, one patient died, and the sixth required further clinical diagnosis. Five other babies were reported dead before the second specimens could be collected for confirmation. It appears that CAH may be one of the underlying causes of death among Thai newborns and the incidence may be higher than thus far shown due to incomplete confirmation of positive screens and deaths to some infants.

Adrenal Hyperplasia, Congenital↗
PubMed2003

Phenylketonuria detected by the neonatal screening program in Thailand.

Neonatal screening for phenylketonuria (PKU) was introduced as a pilot project in Thailand from 1992--1995, and mass screening was started in 1996 by the Department of Medical Sciences, Ministry of Public Health. Blood samples were collected by heelprick on filter paper either at 48 hours of life or before discharge from the hospital. Elevated blood phenylalanine was identified by screening with the Guthrie method, then followed by the fluorometric method: All infants with a phenylalanine level equal to or greater than 4 mg/dl were recalled and retested using the fluorometric method and confirmed by plasma amino acid analysis and urinary pterins for tetrahydrobiopterin deficiency. A total of 1,062,676 newborns were screened from October 1992--March 2001, with 5 cases confirmed with PKU. The incidence was 1 in 212,535. All patients have been treated with low phenylalanine diet. The results of this study confirm the benefit of early detection and treatment of PKU through the screening program.

Biopterins↗
PubMed2005

["Persistence" as possible psychogenetic endophenotype].

For some human traits heritability estimates are well known based on results from twin studies. However, the study of connecting these characteristics to candidate genes in the Human Genome has just been started. The main goal of the recently formulated Human Fenom Project is to define "endophenotypes", characteristics that have considerable heritable component, and can be empirically measured with objective tools, standardized across cultures. Based on our recent findings the VNTR polymorphism in the coding region of the dopamine D4 receptor gene is a candidate gene of the "persistence" trait. Individuals carrying the 7-repeat polymorphism of this allele describe themselves as less persistent. In line with these results the 7-repeat polymorphism was associated to the "persistence" trait as measured by the Junior version of the TCI in a psychiatric sample of children diagnosed with ADHD. Based on these findings our main goal was to define an objective, behavioral measure which could be used as an "endophenotype" in genetic association studies. "Persistence" could be related to responsiveness in a reaction time task demanding sustained attention, for example. This hypothesis was tested using a sample of 35 healthy Caucasian subjects, participating in a extended cognitive reaction time task and filling out the TCI personality questionnaire. Non-invasive DNA sampling was used to determine the candidate polymorphism of the DRD4-VNTR. Results using self-report data replicated our previous findings: the 7-repeat polymorphism was significantly associated to lower "persistence" scores. Individual differences of reaction time were compared using the 7-repeat present/absent grouping as well. Results indicate that responses of individuals with the 7-repeat allele were significantly slower and more variable than of those without this candidate allele. Based on self-report and behavioural measures "persistence" trait is a possible endophenotype of psychogenetic associations.

Character↗
PubMed2005

[Quality assurance in palliative medicine--results of the core documentation of 1999-2002].

Quality assurance has been started in palliative care units since 1999, using a documentation project based on yearly documentation periods. The project was developed by a working party of palliative care specialists in cooperation with the German Cancer Society and the German Association for Palliative Medicine. The aim was a concise but meaningful standard documentation, able to describe the special therapeutic situation of palliative care patients and the interdisciplinary and multi-professional care they receive. In this paper, data of 4693 in-patient treatment periods relating to structural, procedural and outcome quality of palliative care units are presented from the beginning of the core documentation in 1999 through 2001. In 2002, data from palliative care units were compared with those from oncologic and geriatric wards, as well as hospices. Palliative care units show constant traits since the beginning of the core documentation in 1999, in spite of the rising number of participants. At the same time, there are distinct differences among the groups of participants due to the scope of their therapeutic setting. These relate to structure quality in the functional status of the patients (ECOG), which is worst in hospices (> palliative care units > geriatric wards > oncologic wards); to process quality in intensified pain treatment concerning incidence and intensity of pain, which is most frequent and severe in palliative care units (> hospices > geriatric > oncologic wards); and outcome quality in the rate of discharge home, which is highest in oncologic wards (> geriatric > palliative care units > hospices). Quality assurance in palliative care is difficult due to complex indicators, which should be assessed in a standardised documentation. The core documentation was established as a quality assurance programme for palliative care patients. The results of the previous evaluations have enabled the development of a standard documentation. The continuous application of such a standard documentation will prove the quality improvement and development of the participating units.

Documentation↗
PubMed1990

Echinococcosis in Austria.

In 1982, a research project on the prevalence of human echinococcosis in Austria was started. Within the period from 1982 to 1988, data on 188 patients with cystic (CE) and of 16 patients with alveolar (AE) echinococcosis were obtained. 15 out of 16 AE patients and 79 (= 42%) out of 188 CE patients were Austrian nationals, 1 AE patient was of Swiss nationality, and 94% of the 109 non-Austrian patients came from Mediterranean countries. Cases of (presumably autochthonous) cystic echinococcosis were found in Lower Austria, Vienna, Burgenland, Styria, Upper Austria, Carinthia, Salzburg and Vorarlberg, the eastern part of Austria being the main distribution area. Cases of (certainly autochthonous) alveolar echinococcosis were recorded in the Tyrol, in Carinthia and in Lower Austria. At the time of diagnosis, the average ages of Austrian patients with E. multilocularis (49 years) and with E. granulosus (55 years), respectively were significantly higher than those of foreign CE patients (34 years). The finding concerning the localisation of the infection (78% of E. granulosus cysts and 100% of E. multilocularis lesions were located in the liver) are consistent with previously published reports.

Adult↗