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PubMed1997

Caught in the crossfire. Children, guns, and trauma: an update.

The dramatic increase in violence-related deaths in the last few years demands that violence be recognized as a public health emergency. Even though mortality rates in children have decreased overall and deaths from injuries have also decreased, the rate of violence-related mortality has increased. Violence does not know the limits of cities, age, sex, or race; everyone, everywhere is affected. The recognition of violence as a leading cause of mortality and morbidity in children must become a national priority. By making a commitment to tackle the problem of violence, nurses and other health care professionals can make a significant contribution to society at large.

Adolescent↗
PubMed2002

Industry perspectives on ICH guidelines.

In 1990 the International Conference on Harmonization (ICH) effort was begun with the intent of standardizing the drug registration and approval process. The need to rationalize and harmonize regulation was driven by concerns over rising costs of health care, escalation of the cost of research and development and the need to meet the public expectation that there should be a minimum delay in making safe and efficacious new treatments available to patients in need. Since most regulatory agencies have limited resources to interact with sponsor companies, standardized guidelines would help expedite communications with companies at the programme design stage. The ICH is a joint initiative involving both regulators and industry as partners in scientific and technical discussions of the testing procedures which are required to ensure the safety and efficacy of medicines. While all regions of the world have some input to the process, the primary development of the guidelines is derived from industry and regulatory representatives from Europe, Japan and the United States. Much progress has been made in the ten years since the initiation of the ICH, but the implementation and maintenance of the guidelines are in the early stages for most if not all of the published guidelines. If the guidelines do not gain a solid foothold early on, then drift between the regions in use of the guidelines will defeat the goals of the ICH. While the ICH covers the entire drug development process, this paper will review the guidelines that pertain most closely to clinical trials and their use in the drug registration process. Some of the guidelines have been approved and some are still in the development stage.

Drug Approval↗
PubMed1998

Wellness in women after 40 years of age: the role of sex hormones and pheromones.

In the past twenty years hundreds of peer-reviewed studies have provided a significant body of information to guide the health care of women in the second halves of their lives. The harmonic nature of the fertile reproductive system forms the background against which hormonal replacement therapy can be understood to best serve women. In addition, the 1986 discovery of human pheromones and the subsequent 1998 confirmation of their existence increases certain sexual options for maturing women. Not all hormonal replacement therapies and wellness regimens serve women well. Some regimens have the potential to produce disease, especially over-the-counter remedies like dehydroepiandrosterone and the formulas that contain estrogen. Some regimens profoundly improve the quality of life of many women; some women do not need or want such regimens. All sex hormones affect physiologic systems including the cardiovascular system, bone metabolism, cognitive function, sexual response, and sexual attractiveness. The 7 years before menopause have recently been revealed to be an extremely complex era. During this period, some women increase their estrogen levels to new lifetime highs; others start an unequivocal decline, and still others vary from month to month. Coupled to this variability in estrogen is an equally variable set of changes in progesterone secretion by the ovary as androgen secretion patterns also change. Many women show increases in circulating androgens while many others show deficiencies. Both the adrenal and the ovarian sources of these hormones show age-related changes that alter a woman's capacity to attract sexual attention through both her physical appearance (and condition) and her pheromonal excretions. The complex contributions to the overall health of a woman may not always be understood. Often a hysterectomy can exacerbate--rather than ameliorate--the conditions that led to the surgery. One in 2 American women is offered a hysterectomy, a rate 5 times higher than that of the European countries for which data are available. Ninety percent of hysterectomies are not related to cancer; they are elective procedures. Avoidance of elective hysterectomy helps prevent its side effects: sexual deficits, acceleration of cardiovascular and bone disease, and more rapid aging. No efficacy data exist that suggest that elective hysterectomy works better than the alternative approaches that do not induce these side effects. The health and well-being of women who have already had hysterectomies, with or without ovariectomies, can be improved by a recognition of the cascade of difficulties that must addressed. Estrogen, progesterone, and androgens all tend to be compromised by hysterectomy; all should be considered for replacement. Because hormonal regimens can be prescribed to enhance the quality of life, the review of the available research can allow the medical art to greatly benefit mature women. Not surprisingly, the emerging conclusion reveals that structurally human hormones, prescribed appropriately, almost always best serve the patient.

Adult↗
PubMedDate not supplied

Towards a European consensus on conducting and reporting health economic evaluations--a report from the ISPOR Inaugural European Conference.

This report is a summary of key issues in consensus development regarding the conduct and reporting of health economic research in the European context, presented and discussed at the ISPOR Inaugural European Conference in Cologne, Germany, December 1998. Recommendations of the Harmonization by Consensus of the Methodology for Economic Evaluation of Health Care Technologies in the European Union (HARMET) project were presented, as well as two instruments under development: software for Reporting Economic Evaluation Results (REER) and software for collecting and managing cost data called the Health Cost Database Software (HCDS). Working independently, but interrelated with the objectives of the HARMET initiative, preliminary results from the ongoing European Network on Methodology and Application of Economic Evaluation Techniques (EUROMET) project were presented. Each presentation was followed by an expert discussion panel with audience participation. Issues raised included the development of standards and related topics such as usefulness to European decision-makers, and education and training in health economics in Europe.

Journal Article↗
PubMed2004

Retroperitoneoscopic subcapsular nephrectomy for infective nonfunctioning kidney with dense perinephric adhesions.

OBJECTIVE: To evaluate the feasibility and clinical efficacy of retroperitoneoscopic subcapsular nephrectomy for infective nonfunctioning kidneys with dense perinephric adhesions. PATIENTS AND METHODS: Twelve patients underwent retroperitoneoscopic subcapsular nephrectomy; the operative duration, blood loss, intestinal functional recovery time, complications during surgery and efficacy were recorded. Dissociation and ligation of the renal pedicle was the most important step, at which the renal capsule was cut near the renal hilum using a harmonic scalpel, and the fatty tissue around the renal hilum dissected carefully. The renal pedicle was then ligated and divided using an endoscopic linear stapler-cutter after the renal pedicle tissues had been separated to an adequate thickness. RESULTS: All 12 operations were successful and none required conversion to open surgery. The mean (SD, range) operative duration was 82.9 (22.3, 45-120) min, the blood loss 51.4 (12.2, 30-75) mL and the intestinal functional recovery time 12-48 h. There were no complications during or after the surgery, and in the follow-up of 1-15 months the short-term results were satisfactory. CONCLUSION: Retroperitoneoscopic subcapsular nephrectomy can be used safely to remove an infected and heavily adhesive nonfunctioning kidney, with minimal trauma and blood loss, and with faster recovery than after an open subcapsular nephrectomy.

Adult↗
PubMed1998

The functional anatomy of sound intensity discrimination.

The human neuroanatomical substrate of sound intensity discrimination was investigated by combining psychoacoustics and functional neuroimaging. Seven normal subjects were trained to detect deviant sounds presented with a slightly higher intensity than a standard harmonic sound, using a Go/No Go paradigm. Individual psychometric curves were carefully assessed using a three-step psychoacoustic procedure. Subjects were scanned while passively listening to the standard sound and while discriminating changes in sound intensity at four different performance levels (d' = 1.5, 2.5, 3.5, and 4.5). Analysis of regional cerebral blood flow data outlined activation, during the discrimination conditions, of a right hemispheric frontoparietal network already reported in other studies of selective or sustained attention to sensory input, and in which activity appeared inversely proportional to intensity discriminability. Conversely, a right posterior temporal region included in secondary auditory cortex was activated during discrimination of sound intensity independently of performance level. These findings suggest that discrimination of sound intensity involves two different cortical networks: a supramodal right frontoparietal network responsible for allocation of sensory attentional resources, and a region of secondary auditory cortex specifically involved in sensory computation of sound intensity differences.

Adult↗
PubMed2004

Harmonic scalpel tonsillectomy versus hot electrocautery and cold dissection: an objective comparison.

We conducted a large-scale retrospective study to compare the surgical efficacy, practical utility, safety, and costeffectiveness of ultrasonic harmonic scalpel tonsillectomy, hot electrocautery, and cold surgical dissection. We based our findings on the length of operating time, complication rates, the length of hospital stay for patients with complications, and relative costs. We then compared our findings with those published in earlier reports, none of which were based on a three-way comparison. Our study population was made up of 316 patients--175 males and 141 females aged 1 to 23 years (mean: 7.3)--who had undergone adenotonsillectomy or tonsillectomy alone at our tertiary care children's hospital between Sept. 1, 2000, and Aug. 31, 2001. The harmonic scalpel was used on 75 patients (23.7%), electrocautery on 109 patients (34.5%), and cold surgical dissection on 132 (41.8%). The mean length of operating time for adenotonsillectomy was 42.4 (n = 70), 43.0 (n = 103), and 49.2 (n = 95) minutes, respectively; the corresponding times for tonsillectomy alone were 23.6 (n = 5), 30.2 (n = 6), and 35.3 (n = 37) minutes. Overall complication rates were 2.7, 5.5, and 6.1%, respectively. Hospital stays for immediate (<24 hr) postoperative bleeding averaged 2.0, 1.0, and 0.7 days, respectively, and stays for dehydration averaged 1.0, 1.3, and 1.5 days. Mean per-patient institutional costs were 460.00 dollars, 310.75 dollars, and 300.00 dollars, respectively. We conclude that harmonic scalpel tonsillectomy is efficacious, practical, safe, and cost-effective, and we recommend that any institution involved with a significant number of pediatric tonsillectomies consider using it.

Adenoidectomy↗
PubMed1996

Medicare managed care and the need for quality measurement.

With the increasing penetration of managed care as health insurance coverage for Medicare beneficiaries, accountability for quality of care is being demanded. While HEDIS 2.5 has become the standard for assessing the performance of health plans in caring for their commercial members, no such standard exists for Medicare enrollees. U.S. Quality Algorithms, the performance measurement subsidiary of U.S. Healthcare, has developed the Medicare Quality Report Card as a tool for performance assessment and quality improvement. This article describes how the measures of quality important to the Medicare population were chosen, how the measures were calculated, and how they have been used in programs designed to improve the quality of care for U.S. Healthcare Medicare members.

Aged↗
PubMed1985

Myoelectric response of the human triceps brachii to displacement-controlled oscillations of the forearm.

The dynamic relations between the surface myoelectric activity in tonically contracting triceps brachii and the forearm rotation (proportional to triceps stretch) were measured by imposing small, sinusoidal, displacement-controlled perturbations on the forearm position. Three normal, adult, male subjects participated in these experiments. The amplitude of the forearm rotation, the driving frequency, and the tonic contraction level were all carefully regulated. The mean rectified triceps EMG (the output) showed a strong harmonic at the driving frequency, and the frequency-response characteristics were computed directly by comparing the amplitude and phase of this harmonic to that of the forearm flexion angle (the input). The (electrical) reflex gain is defined as the amplitude ratio of output to input. The system response was measured from 2 to 18 Hz, at two tonic contraction levels and two forearm rotation amplitudes, about a mean position of 90 degrees forearm flexion. The results show clearly that the system response is nonlinear: the reflex gain decreases with forearm rotation amplitude. (This gain also increases with tonic contraction level for sufficiently low values of the latter variable.) The measured frequency-response characteristics of the system can be modeled approximately as a second-order linear lead filter with a single time delay, followed by a saturating nonlinearity. Both model-independent estimates and least-squares model fitting, yielded values of the time delay of the order of 25 ms, suggesting that a segmental mechanism mediates reflex activity. Simplified calculations and limited measurements are presented to show that a nonlinear system of the type we have identified with constant displacement driving may appear linear under constant torque driving. Our directly-measured frequency-response characteristics differ from those reported by investigators employing random, rather than periodic, driving; possible reasons for these apparent discrepancies are discussed.

Arm↗
PubMed2005

Non-malignant occupational respiratory diseases in Germany in comparison with those of other countries.

OBJECTIVE: To present recent data on the occurrence of non-malignant occupational airway diseases in Germany and to compare mainly affected occupations of obstructive airway diseases caused by allergens and irritants with available surveillance data from other countries. METHODS: Sources of German data were statistics for the year 2003 of the Ministry of Labour and Social Affairs and of the federation of statutory accident insurance institutions for the industrial sector. RESULTS: Confirmed cases of non-malignant occupational respiratory diseases in Germany are mainly benign asbestos-associated diseases (occupational disease no. 4103: 1,975 cases), silicosis/coal worker's pneumoconiosis (occupational disease no. 4101: 1,158 cases), obstructive airway diseases due to allergens (occupational disease no. 4301: 935 cases), chronic obstructive bronchitis and/or emphysema in hard coal miners (occupational disease no. 4111: 414 cases), obstructive airway diseases due to irritants and toxic agents (occupational disease no. 4302: 181 cases), diseases caused by ionising radiation (171 cases), diseases due to isocyanates (occupational disease no. 1315: 55 cases), and 22 cases of other rare occupational lung and airway diseases. Miners, bakers, chemical workers, hairdressers and health care workers are mostly affected. Bakers were also frequently affected by occupational asthma in Finland, France, Sweden, the United Kingdom, the Piedmont region in Italy, South Africa, and New Zealand. Further, high frequencies of occupational asthma were reported for health care workers in France, Italy, New Jersey, Michigan, and South Africa. CONCLUSION: Despite completely different legal definitions and regulations, comparably high numbers of occupational obstructive diseases in western countries require better primary and secondary prevention in industries with high incidence, especially in bakeries, the health care sector, farming, and mining. Furthermore, there is a urgent need for harmonization of recognition and compensation systems for occupational diseases as well as of respective preventive strategies within the European Union.

Adult↗
PubMed2000

Elevated picture completion scores: a possible indicator of hypervigilance in maltreated preschoolers.

OBJECTIVE: The Picture Completion subtest of the Wechsler Preschool and Primary Scales of Intelligence-Revised (WPPSI-R) measures visual alertness and the ability to differentiate essential from nonessential details. In children who are hypervigilant as a result of maltreatment, these skills may be over-functioning. It was hypothesized that the Picture Completion subtest scores of these children would be significantly elevated in comparison to their other nonverbal scores and their overall intellectual functioning. METHOD: Fourteen children from a therapeutic day treatment preschool program for maltreated children were administered the WPPSI-R. Standardized discrepancy scores between Picture Completion scores and Performance mean scores (PC-Performance Discrepancy) and the mean of all subscale scores (PC-Overall IQ Discrepancy) were formed and then analyzed. RESULTS: The abused preschoolers scored significantly lower than the population mean on four of the five WPPSI-R Performance subscales. Only on Picture Completion did they score significantly higher. Average PC-Performance Discrepancy and PC-Overall IQ Discrepancy scores were greater than one, indicating that the mean difference of children's Picture Completion score from either their Performance mean score or all of their mean scores was more than one standard deviation. CONCLUSION: Elevated Picture Completion score may serve as a marker for hypervigilance and/or PTSD in children with histories of maltreatment.

Arousal↗
PubMed1988

Harmonic convergence.

Explore the source record for details and available documents.

Clinical Nursing Research↗
PubMed2005

Amplitude and phase control of attosecond light pulses.

We report the generation, compression, and delivery on target of ultrashort extreme-ultraviolet light pulses using external amplitude and phase control. Broadband harmonic radiation is first generated by focusing an infrared laser with a carefully chosen intensity into a gas cell containing argon atoms. The emitted light then goes through a hard aperture and a thin aluminum filter that selects a 30-eV bandwidth around a 30-eV photon energy and synchronizes all of the components, thereby enabling the formation of a train of almost Fourier-transform-limited single-cycle 170 attosecond pulses. Our experiment demonstrates a practical method for synthesizing and controlling attosecond waveforms.

Journal Article↗
PubMed1989

Twenty-four-hour ambulatory blood pressure in shift workers.

Blood pressure and heart rate of 15 male shift workers were measured every 15 minutes for 24 hours during three work shifts: morning, 4:00 AM to noon; afternoon, noon to 8:00 PM; and night, 8:00 PM to 4:00 AM. For each shift, 24-hour systolic and diastolic blood pressure showed a large "trough" (the low pressure span) and a continuous range of elevated pressure (the high pressure span). Fourier series were used to model the 24-hour blood pressure profiles. A careful examination of the residuals (measured minus predicted pressures) showed that four harmonics were necessary to describe the data accurately. The model enabled localization in each blood pressure profile of the high and low pressure spans that did not coincide with the subject's work and rest periods. The time and slope of blood pressure entering and leaving these spans could also be individually determined. Mean blood pressure during the high pressure span was the same for the three shifts, but mean blood pressure during the low pressure span was lower when the subject worked in the afternoon. During that shift, the systolic blood pressure slopes entering and leaving the low pressure span were steeper than during the two other shifts. The high pressure span was longest during the night shift and shortest during the afternoon shift. Therefore, a change in the working time profoundly perturbed the 24-hour blood pressure profile.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Acculturation and cervical cancer: knowledge, beliefs, and behaviors of Hispanic women.

In a community-based sample of Hispanic women, this study examines differences in relation to level of acculturation in knowledge about the Pap examination, fear/fatalism towards cancer, and cervical cancer screening behaviors. Respondents were randomly chosen from 11 churches in the Phoenix metropolitan area (n = 566) and were categorized into three acculturation levels: low (35.2%), bicultural (26.3%), and high (38.5%). Interviews focused on family history of cancer as well as knowledge about cancer and utilization of screening techniques for breast and cervical cancers. OLS regression and probit analyses were conducted to examine the role of acculturation in differentiating. Hispanic subgroups in relation to knowledge, beliefs, and behaviors regarding cervical cancer. Findings of the present study indicate that Hispanic women in the Phoenix metropolitan area are utilizing cervical cancer screening services with over 90 percent of women in all three acculturation groups ever having had a Pap exam and more than 50 percent having had the examination during the past year. However, results also indicate that of the Hispanic subgroups examined, lower acculturated Hispanic women have less knowledge about Pap smears and exhibit lower utilization rates for cervical cancer screening. These results suggest that lower-acculturated Hispanic women comprise the subgroup of Hispanics that is at greatest risk of presenting with advanced stages of cervical cancer. Results have implications for cancer screening and education programs for Hispanic women as well as implications for health care professionals who serve this population.

Acculturation↗
PubMed2000

[Prediction on the medical care system for the aged people in the new century].

Japan has become the country with the longest life expectancy in the world in about 25 years. Among many factors for this success, the medical care system, including the health insurance for everyone, played the important role, which has been evaluated as the best in the world. However, since the national economy in Japan has become recently suppressed it has become one of the big political problems to keep this system as same as before. In addition, the medical expenses for the elderly and aged people is now as high as 40% of all. In this meaning, we should create the better system by ourselves, based on ethical criteria, harmonized with the progress of medicine. In April of 2000, the new long term care system was introduced aiming the self independence of aged people. Now, the medical and long term care system has become unified into one toward the ideal society in the future. In this paper, the ideal medical care system, especially for the aged people was discussed. Needless to say, the medical care system should have widely view to the future. The progress of medicine, high technology and health promotion will play very important parts to create the ideal society in future. If any geriatric diseases including senile dementia will be settled in near future, the medical care system for the aged will change completely. In addition, the nationwide campaign of health promotion will induce excellent results. Thus the society in the future will become much brighter and happier. In this meaning, health promotion, medical care, and welfare systems should be unified into one system. The expenses for these systems should be regarded as the investments expecting the huge profit in health and happiness in the future.

Aged↗