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PubMed1995

[Rehabilitation access for emotionally handicapped children and adolescents: qualification of standard institutions--construction of special institutions].

In order that pedagogic institutions in the system youth care can take care of children and youths who are mentally disabled due to a mental disturbance in the manner necessary certain institutional conditions must exist. For a small group of youths with especially severe mental disorders additional special ambulatory and in-patient assistance offers are necessary. This special need is explained with examples. General standards and special institutions are described in detail. A reliable cooperation between the system of youth care and the individual expert departments in the child and youth psychiatry is conditional for the effectiveness of the assistance offers.

Adolescent↗
PubMed1996

[History of "special therapeutic directions": the example of homeopathy].

As for generally accepted therapeutic methods, the "special methods" may appear to be effective due to spontaneous recovery provided by nature. A great number of sceptical physicians are aware of this fact. The pharmacologist works continuously to differentiate effects directly caused by medical treatments - mainly drugs - from effects resulting from spontaneous recovery. This is one of the most difficult problems in medical treatment. As a representative example of all "special methods", we concentrate here on the history of homeopathy. As is generally known, there is no conformity in homeopathy, for example monotherapy versus therapy with complex homeopathic products; refusing the simile-rule; treatment with high potencies versus treatment with low potencies; classic versus scholastic homeopathy. The number of homeopathies really equals the number of homeopathic physicians. For this reason, instruction in homeopathy on the academic level is impossible. In addition, we have to forget all natural laws only to prove that "potentiation" may be true. Therapeutic success due purely to chance may be explained rationally and is occasionally seen in all other "special methods". The theories of homeopaths for the action with homeopathic products are neither in accordance with our natural laws nor comply with a rational philosophy.

Complementary Therapies↗
PubMed1996

Assessment and rehabilitation of children with special needs.

Evaluating the visual functioning of children with multiple impairments has long been a source of frustration for many eye care practitioners. A reflection of this difficulty is seen in the number of persons with multiple handicaps, especially children who are labeled "untestable" or "blind" by eye care specialists, but whose parents, teachers, and other caregivers know have some residual vision. These children with special needs may not be responsive to standard testing procedures for a variety of reasons. Stress-related behaviors, orthopedic and neuromuscular disorders, mental retardation, and preverbal levels of development will often greatly interfere with communication and co-operation levels. As parents, educators, and rehabilitation professionals have become aware of the importance of vision in the development of any child, the demand for comprehensive functional vision evaluations has substantially increased. The purpose of this paper is to present a functional vision evaluation for a child with special needs. Although one case is given as an example, guidelines for the evaluation of all special needs children are presented. It is important for eye care specialists to utilize these examination procedures in order to provide a framework from which comprehensive vision services can be delivered in conjunction with available community resources.

Child↗
PubMed1997

[Legal regulation of special medical procedures].

Physicians in The Netherlands largely determine amongst themselves how they treat patients, whereas statutory regulations mostly concern indirect matters, such as qualifications of the treating persons, quality of care and patients' rights. Special items of service are currently reserved for special institutions. When the new Special Medical Services Act is passed, the minister is empowered to prohibit items of service if he/she considers these undesirable for social, ethical or legal reasons. More discussion is needed before such sensitive matters are to be regulated by law.

Clinical Competence↗
PubMed1996

[The outcomes of the surgical treatment of a bleeding duodenal ulcer at a specialized provincial center].

Gastroduodenal bleedings were surgically treated in 244 patients with bleeding duodenal ulcers at the regional specialized center of treatment of gastroduodenal bleedings during 5 years. Postoperative lethality was 9.4%. A classification of surgical operations for bleeding ulcers is proposed depending on the time of performing. Substantiation is given to expediency of specialized medical care of such patients at the specialized center.

Duodenal Ulcer↗
PubMed1997

Changes in the aerobic capacity and ultrastructure of skeletal muscles and myocardium of endurance training rats induced by specialized food supplements with different compositions.

In order to find how the aerobic capacity and the ultrastructure of the skeletal and heart muscle cells of endurance training rats change as a result of adding two dietary supplements with different compositions to their diet (our own dietary formula specially designed for endurance sports and Aufbau Konzentrat, a product of Pfrimmer, Germany)--we carried out an experiment with 16 Wistar rats divided in two groups. The animals from group A received a food mixture containing 76% standard rat chow and 24% of the endurance training supplement, and those from group B--a food mixture of 76% standard rat chow and 24% Aufbau Konzentrat. Both supplements contained a high-quality protein, but those designed for endurance training was of higher fat and lower carbohydrate content. The animals were subjected to training on a treadmill at submaximal loading for 8 weeks. Initially and at the end of the experiment (week 9) VO2max-test was performed and VO2max and RQ variables of the treated animals were evaluated. At the end of the experiment the maximum oxygen intake was greater in group A animals than that in group B rats--85.06 +/- 8.81 and 75.77 +/- 4.91 ml O2.kg-1.min-1, respectively. After eight weeks a material from m. gastrocnemius and from the left cardiac ventricle of all animals was obtained and treated for transimmersion electron microscopy. Morphological data for more intensive oxidative processes in the gastrocnemius muscle and myocardium of group A animals were evident. The greater number of mitochondria and the higher cristae density observed in the gastrocnemius muscle cells indicated a better aerobic adaptation induced by the training and the intake of the specially designed supplement for endurance sports. Within an 8-week period of submaximal training using the specially adapted food formula resulted in a better structural basis than Aufbau Konzentrat produced in the skeletal and heart muscle cells for improvement of the aerobic capacity.

Aerobiosis↗
PubMed1997

MHC class II compartments: specialized organelles of the endocytic pathway in antigen presenting cells.

Mounting an immune response against foreign, extracellular material requires that this material be internalized by antigen presenting cells, processed to peptide fragments and then displayed on the cell surface for recognition by the T cell receptor on T helper cells. Such peptides, derived from internalized antigens are generally presented to T cells in association with Major Histocompatibility Complex (MHC) class II molecules. Recent work has identified subcompartments of the endosomal/lysosomal system that appear to be important sites for the generation of peptide-MHC class II complexes. These so-called MHC class II compartments receive antigenic fragments from endosomes and lysosomes and load them onto class II molecules. From these compartments, peptide-loaded class II molecules are transported to the plasma membrane, where they can trigger T cells bearing appropriate receptors. This review summarizes recent work characterizing MHC class II compartments as specialized organelles of the endosomal/lysosomal pathway. Interestingly, MHC class II compartments share many features common to organelles present in a wide variety of specialized cells with quite different functions. Modifying the endocytic pathway to serve the needs of specialized cells may be a common mechanism which allows very different cell types to carry out their disparate functions.

Animals↗
PubMedDate not supplied

[The hemispheric functional specialization of visual perception].

In this review the modern concepts on psychophysical mechanisms of hemispheric functional specialization of human visual perception are considered. The problems are discussed on three basic historical aspects: interhemispheric relations in patients with localized cerebral lesions, interhemispheric differences in the "Bisected Brain", and the functional asymmetry in the intact brain. The neuropsychological data on recognition of geometric figures, faces and objects, and also electrophysiological results on the event-related brain potentials are deliberated. Special attention is given to the own data of authors dedicated to importance role of the right hemisphere in the brain interhemispheric functional asymmetry in control subjects and alcoholics. Several problems on learning and influence of emotions on visuospatial recognition are discussed. The dichotomous approach to brain functional asymmetry are not shared, the hypothesis on intersupplementary cooperation in hemispheric specialization and interaction of the brain hemispheres are supported.

Alcoholism↗
PubMed1998

[Long-term survival of patients with hypertension treated in general practice or at a specialized hypertension clinic. A 21-year observation study of 831 patients with hypertension].

This article is based on a study first published in Blood Pressure. After an initial diagnostic and therapeutic assessment at a specialized hypertension clinic, 831 patients with primary hypertension were during a 15-year period allocated to continuing managing care either by their general practitioner or by the hypertension clinic. Survival was assessed in the two groups: general practice (n = 437, 223 males, 214 females) and specialized hypertension clinic (n = 394, 208 males, 186 females). Median observation times for both groups were 11 years. There were no significant differences between the groups concerning age at entry, pretreatment clinical status, pretreatment blood pressure or treated blood pressure level before allocation. Judged by a Cox' regression model, no difference in survival between the two groups could be registered. The leading cause of death in both groups was ischemic heart disease. Our results indicate that after the initial diagnostic assessment and adjustment of treatment, managing care in a specialized hypertension clinic offers no advantage concerning survival compared to managing care in general practice.

Adult↗
PubMed1976

[Development of specialized cooperative animal production units of the agro-industrial type in the USSR].

The development of Soviet agriculture, especially the animal production, is outlined. It proceeded from the formation of socialist large farms with a versatile production profile--mostly comprising all kinds of animals--towards establishing specialized departments (farms) in these cooperatives and, in recent years, towards the development of large production units with a specialized production profile on an industrialized basis (animal farming complexes). Specific probelms of the transition towards specialized production of and with cattle in large units are discussed. The formation of cattle-fatening enterprises is outlined on the basis of experiences gained in the Southern part of the European part of the RSFSR in the Krasnodar region since that middle of the 1960s. The effectiveness of beef production in this new type of enterprise lies well beyond the results reached in the traditional collective and state farms, although it has not yet reached the target set of the state animal production complexes. The cooperative cattle fattening farms can be considered part of future agro-industrial complexes and can actually become part of these.

Agriculture↗
PubMed1992

[Highly specialized medicine. How to assign the tasks?].

Norway has four million inhabitants and five university hospitals, each serving one health region. The authors describe the work of a governmental medical committee, whose mandate is to advise on where to locate the various highly specialized medical services. Important questions have been the relationship between experience and quality, and the desire of each university clinic to be able to provide treatment within its own region for most health problems. Their reasons are concern about research and specialist training, and the preference of patients for treatment near to home. A list of proposed national and over-regional centers for certain treatments has been prepared on the basis of the experts' report and comments from all university clinics. These recommendations have provided a medical basis for later economic and political analyses prior to final decision by the Government. Norwegian legislation permits strong governmental regulation of the highly specialized health services.

Health Planning↗
PubMed1987

Physician familiarity with the educational programs of their special needs patients.

As part of an analysis of health care for children in special education programs, physician familiarity with the educational status and program enrollment of their disabled patients was examined. Telephone interviews were performed with a random sample of 411 of the children's physicians. The majority (70%) of the physicians interviewed professed no knowledge of their patients' current special educational program. Certain physician, child, and family characteristics were associated with physician awareness of the children's programs. These were physician specialty, physician gender, child's disability, and severity of the child's problem. This study suggests that, although some physicians of very involved patients do familiarize themselves with their patients' day-to-day school life, many other physicians are poorly informed about the school activities and functional status of their young patients with disabilities. Better mechanisms are needed to ensure physicians' understanding of these aspects of child health.

Affective Symptoms↗
PubMed1985

Medical examination of children referred for special education.

The results of medical examinations of 184 children referred for special educational services were reviewed, with particular attention paid to the value of the examination in the detection of abnormalities that would have an adverse educational impact and of previously undiagnosed abnormalities. Seventeen students (9%) were found to have educationally important abnormalities previously unknown to the school. Fifteen students had abnormalities detected through screening tests. The two remaining students had abnormalities apparent on physical examination that conceivably could interfere with physical education but should not hinder academic achievement. Thus, a separate physical examination, apart from those recommended for all children by the American Academy of Pediatrics, may not be productive for children referred for special educational services, but screening tests currently available in many schools are more likely to be beneficial.

Adolescent↗
PubMed1998

Cost efficiency, factor interchange, and technical progress in US specialized hospital pharmacies.

Specialized hospitals perform unique, technologically more complex, and relatively expensive medical procedures. Growing use of high-cost biotechnology drugs and increased clinical pharmacy tasks at these facilities have increased costs. This paper used a unique data set supplied by Eli Lilly, and a dual translog cost system to model the costs of specialized hospital pharmacy production. Results show that the potential substitution of pharmacy technicians for registered pharmacists and the decomposed technical change savings effects of expensive factors of production offer the greatest opportunities for containing costs. Slight diseconomies of scale were also observed.

Cost Control↗
PubMed1992

Special education placements of language-disordered children in a psychiatric population.

Children evaluated by an interdisciplinary team that provided data on psychiatric disturbance, language handicaps, and psychoeducational assessment were placed in special education classes following the complete evaluation. Discriminant analysis as a special case of multiple regression analysis determined that mean reading achievement score, pre-evaluation classroom placement, and to a lesser degree, Performance IQ predicted classroom placement. Overall, correct classroom predictions approached 90 percent. These findings highlight the value of interdisciplinary evaluation to educators and mental health professionals.

Achievement↗
PubMed2001

The value of specialization--is there an outcome difference in the management of fistulas complicating diverticulitis.

PURPOSE: The value of specialization has frequently been challenged by many health care institutions and providers. This review was conducted to determine whether there were any outcome differences in the management of fistulas complicating diverticulitis. METHODS: We conducted an historical cohort study using hospital charts of all cases of fistulas complicating diverticulitis that were operated on in four university-affiliated hospitals between 1975 and 1995. There were 122 patients, with 37 under the care of fully trained colorectal surgeons and 85 under the care of general surgeons. RESULTS: There were no significant differences in patient demographics, preoperative comorbidities, or the number of preoperative diagnostic investigations between the two groups. The colorectal surgeons performed more intraoperative ureteral stenting (Colorectal Surgery 55.5 percent vs. General Surgery 24.4 percent, P = 0.001). The general surgeons performed more initial diverting Hartmann's and colostomy procedures (Colorectal Surgery 5.4 percent vs. General Surgery 27 percent, P = 0.013). The patients in the General Surgery group had longer preoperative lengths of stay (median Colorectal Surgery 3 (range, 1-28) days vs. General Surgery 8 (range, 0-29) days; P < 0.001), longer postoperative lengths of stay (median Colorectal Surgery 11 (range, 5-40) days vs. General Surgery 14 (range, 2-80) days; P = 0.001), and longer total lengths of stay (median Colorectal Surgery 14 (range, 6-62) days vs. General Surgery 24 (range, 6-100) days; P < 0.001). The patients in the General Surgery group experienced a higher rate of wound infections (Colorectal Surgery 5.4 percent vs. General Surgery 12.9 percent), and a larger proportion of them experienced complications (Colorectal Surgery 27 percent vs. General Surgery 41.2 percent). CONCLUSIONS: We conclude that specialization in colon and rectal surgery contributed to an improved outcome, with a lower rate of diverting procedures, a shorter hospital stay, and a lower rate of complications.

Canada↗
PubMed1996

Substance abuse differences among students receiving special education school services.

Social fragility is used as a context for explaining reported substance abuse differences between disabled children and youth receiving special education school services. Characteristics of severely behaviorally handicapped, specific learning disabled and developmentally handicapped are summarized. Reported use of cigarettes and other drugs are summarized for elementary, junior high and high school students. Differences in patterns of use between special education populations at each level of schooling and regular education students are identified and explored. Differences are interpreted in terms of social attachment and cognitive functioning issues.

Adolescent↗
PubMed2006

Grade failure and special education placement in sexual offenders' educational histories.

A sample of 701 adult men underwent assessment following illegal or clinically significant sexual behaviors or interests. Patients were categorized on the basis of phallometric (penile) responses in the laboratory to erotic stimuli depicting adults, pubescent children, and prepubescent children; histories of sexual offenses; and self-reported sexual interests. Comprising the categories were men sexually interested in prepubescent children (pedophiles; n = 114), men sexually interested in pubescent children (hebephiles; n = 377), men sexually interested in adults and who had committed a sexual offense against an adult (teleiophilic offenders; n = 139), and men sexually interested in adults and who had no known history of any sexual offenses (teleiophilic nonoffenders; n = 71). Patients' assessments included IQ testing and self-reported academic history, which included any grade failures and assignment to special education classes. Relative to the teleiophilic offenders, both the pedophilic and the hebephilic groups showed approximately double the odds of failing a grade or being enrolled in special education, both before and after covarying IQ. No significant differences were detected between the teleiophilic offenders and the teleiophilic nonoffenders. These data are consistent with the hypothesis that an erotic age preference for children sometimes results from a perturbation of neurodevelopment occurring early in life.

Adult↗