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PubMed1994

[Palmar burns of the hand in children. 81 cases].

The authors reviewed 81 children between the ages of 5 months and 3 years suffering from palmar burns of hands from 1988 to 1992. Most burns were unilateral (53), superficial 2nd degree (48), due to contact (55), in boys (48) and only affecting the palm (69). The initial treatment consisted of directed healing followed by a split-skin graft in 8 cases. The initial scar was not retracted in 58 cases, retracted in 17 cases and hypertrophic in 8 cases. 79% of children had no sequelae at 12 months. At more than three years, 15% of children (12) had sequelae: 9 adhesions of the first commissure, 5 flexion deformities of long fingers, 3 clinodactylies, 1 syndactyly. All were operated by trident plasties, Colston flaps or full-thickness skin graft. A final functional assessment was performed. 90% of children had no sequelae. Four children still presented moderate functional discomfort (3 adhesions of the first commissure requiring reoperation, one case of decreased sensitivity). Palmar burns in children have a good prognosis. Factors of severity are: involvement of the 1st commissure, associated dorsal burn, deep 2nd degree, poor social conditions, delayed management.

Burns↗
PubMed2002

Incidence of breast cancer on Crete, 1994-1995.

The aim of this study was to present epidemiological results relating to malignant neoplasms of breast using primary data from the island of Crete, Greece, 1994-1995. The patients were all female residents of Crete with breast cancer first diagnosed during 1994 and 1995, 208 and 207 new incident cases, respectively. The data were collected and analysed by the Cancer Registry of Crete (CRC). Direct age-standardised rates (ASR) for incidence and cumulative risk (to age 75 years) were calculated for Crete as a whole. Standardised incidence ratios (SIR) were calculated for the 20 provinces (administrative regions); these were also smoothed using Bayesian methods. The ASR for incidence per 100000 person-years was 70.6. The truncated rate (age 40 years and above) was 153.7. The SIR for the 20 provinces showed no marked variations, with three exceptions, two of which had ratios higher than 1 and one lower. Bayesian smoothing of provincial incidence rates showed that throughout Crete, the risk of breast cancer shows considerable uniformity. The incidence rate of breast cancer on Crete is higher than that of Greece overall, and is comparable with other southern European countries. A possible explanation is that the published incidence for Greece may be an underestimation of the true rate. The small variability in breast cancer incidence within Crete probably reflects the homogeneity of the population and environmental and social conditions.

Adult↗
PubMed2003

Biopsychosocial issues and risk factors in the family when the child has a chronic illness.

Between 10 and 20 million American children and adolescents have some type of chronic health condition or impairment. There has been a recent interest in the psychological aspects--emotional and behavioral--of chronic illness in children and adolescents. Major new areas of science, such as behavioral medicine, have emerged to address the research and clinical demands of this field. Several studies already have demonstrated the increased risk for psychiatric problems in children with chronic health conditions to be three to four times greater than their healthy peers. The proposed perspective shifts from a traditional sole reliance on medical diagnosis to a focus more on the dimensions of adjustment, socioeconomic status, visibility of condition, social support, and family functioning.

Adaptation, Psychological↗
PubMed1998

Factors leading to delay in diagnosis of invasive cervical cancer.

Objective: Screening for cervical cancer has been one of the major successes in American health care. The reasons for screening failure have not been well described. We have encountered 24 patients in the past year on our gynecologic oncology service who have presented with grossly visible stage IB or higher cervical cancers. A questionnaire was developed to determine why these patients presented with invasive cervical cancer, a theoretically preventable disease.Methods: All patients seen at our hospital center with grossly visible cervical cancer were offered entry into this prospective study, approved by the IRB. After informed consent was obtained, a questionnaire was administered to the patients by a physician. The questions involved sexual and gynecologic history, symptom review, social history, and personal concerns involving gynecologic exams. Twenty-four patients were approached for the study and 20 were enrolled. Four patients were unable to participate secondary to medical or social conditions that did not allow them to complete the questionnaire.Results: Of the 20 patients enrolled in this study, 14 of 20 (70%) presented with bleeding irregularities. Upon further questioning, 19 of 20 (95%) reported a history of abnormal bleeding. Only 3 of 20 (15%) patients reported a history of an abnormal Papanicolaou smear, and 7 of 20 (35%) reported not having had a Papanicolaou in the past 5 years. Two patients had never had a Papanicolaou smear. Seventeen of 20 (85%) of all patients in the study had medical insurance at the time of diagnosis, and only 2 patients reported lack of insurance as the reason they had not been seen by a gynecologist in the past 2 years. The majority of the study patients, 17 of 20 (85%) had contact with medical personnel in the 2 years prior to diagnosis. Sixteen of the 20 patients had been seen by a physician, 5 of 20 had surgery or other invasive procedures, and 6 of 20 had been seen in an emergency department. Only 5 of 20 patients knew that a Papanicolaou smear is a screening test for cervical cancer. Five of the 20 thought it to be a test for infections, and 10 of 20 did not know the purpose of a Papanicolaou smear. The main reason women gave for not having had a Papanicolaou smear in the past 2 years was that they felt healthy and had no symptoms (12/20).Conclusion: The majority of patients in our study (17/20) reported contact with a physician within 2 years of diagnosis of their invasive cervical cancer. It appears that failure to screen and lack of understanding regarding Papanicolaou smear screening, rather than lack of access to medical care, is a major cause for delay in diagnosis of cervical cancer.

Journal Article↗
PubMed2005

Sex differences in pain perception.

BACKGROUND: A number of studies have demonstrated a higher prevalence of chronic pain states and greater pain sensitivity among women compared with men. Pain sensitivity is thought to be mediated by sociocultural, psychological, and biological factors. OBJECTIVE: This article reviews laboratory studies that provide evidence of sex differences in pain sensitivity and the response to analgesic drugs in animals and humans. The biological basis of such differences is emphasized. METHODS: The literature from this relatively new field was surveyed, and studies that clearly illustrate the differences in pain mechanisms between the sexes are presented. Using the search terms sex, gender, and pain, a review was conducted of English-language literature published on MEDLINE between January 1980 and August 2004. RESULTS: Although differences in pain sensitivity between women and men are partly attributable to social conditioning and to psychosocial factors, many laboratory studies of humans have described sex differences in sensitivity to noxious stimuli, suggesting that biological mechanisms underlie such differences. In addition, sex hormones influence pain sensitivity; pain threshold and pain tolerance in women vary with the stage of the menstrual cycle. Imaging studies of the brain have shown differences between men and women in the spatial pattern and intensity of response to acute pain. Among rodents, females are more sensitive than males to noxious stimuli and have lower levels of stress-induced analgesia. Male rodents generally have stronger analgesic response to mu-opioid receptor agonists than females. Research on transgenic mice suggests that normal males have a higher level of activity in the endogenous analgesic system compared with normal females, and a human study has found that mu-receptors in the healthy female brain are activated differently from those in the healthy male brain. The response to kappa-opioids, which is mediated by the melanocortin-1 receptor gene in both mice and humans, is also different for each sex. CONCLUSION: Continued research at the genetic and receptor levels may support the need to develop gender-specific drug therapies.

Analgesics↗
PubMed2003

The secular trend in human physical growth: a biological view.

Nutritionists and anthropometric historians alike are familiar with the secular trend-height and weight in adults, and the rate of physical development in children, increasing since at least the mid 19th century. The social conditions which drive this trend are of interest to anthropometric historians, but the underlying biology is also important. Here the trends for height, weight and menarcheal age are summarised and contrasted. In Northern Europe, adult height has largely stabilised, and the age of menarche has also settled at around 13 years, while weight continues to increase due to obesity. The increase in height from one generation to the next occurs mainly in the first 2 years of life, due to increases in leg length. The height trend has lasted for 150 years or more, i.e. for six generations, because the rate of catch-up from one generation to the next is biologically constrained to avoid the cost of too rapid catch-up.

Adult↗
PubMed2003

The ups and downs of Mexican economic growth: the biological standard of living and inequality, 1870-1950.

The secular change in the biological standard of living of the Mexican population between 1870 and 1950 is examined based on evidence on the physical stature from military and passport records. While Mexico industrialized and experienced rapid economic growth during this period, there was only a modest overall improvement in the height, health and nutritional status of the Mexican population. The average Mexican born in the 1940s was not only slightly taller than its compatriot of the 1870s. There were, however, considerable social differences: the Mexican upper class was markedly taller than the working class and the gap increased prior to the revolution. Economic growth with systemic inequality largely accounts for such a pattern.

Adult↗
PubMedDate not supplied

Alternative and complementary healing: implications for nursing.

The current interest in alternative and complementary therapies is examined within the social context of technology, economics, and philosophical beliefs of a culture that is moving from the Industrial Age into the Information Age. A philosophical shift toward ecology, religion, and spirituality coincides with a shrinking global perspective resulting in increased accessibility to healing ideologies from other cultures. The community of alternative and complementary healers is responding to these social conditions by offering healing modalities congruent with public interests. Responses of the health care industry are discussed as are the similarities of alternative and complementary healing to nursing practice. Implications for nursing research, practice, and education are suggested.

Complementary Therapies↗
PubMed1999

Probabilities of marriage in two outer Hebridean islands, 1861-1990.

A study has been made of the probabilities of marriage of females and males aged 15-49 (either as a whole or in 5-year age groups) in two Outer Hebridean islands, Harris and Barra. The results were compared with ages of marriage and with the frequencies of permanent celibacy. The marriages took place between 1861 and 1990. Median ages of marriage rose to maxima in the 1930s and 1940s, then fell steeply, levelling out latterly. Permanent celibacy was consistently high among females, but rose from much lower levels in males to maxima in the 1970s and 1980s. It is concluded that in these populations age at marriage and the extent of permanent celibacy are largely independent of one another. In both islands the overall probabilities of females marrying fell until the 1920s, and then rose. The last decades showed stability (Barra) and a fall (Harris). Males showed only slight falls to about 1910; data were absent for between 1911 and 1960, but subsequently there was little rise in probability. These overall changes seemed to be associated with reciprocal variations in probabilities in the younger and older age groups. Declining overall probabilities were associated with declines in younger and increases in older age-group probabilities, and vice versa. Non-parametric correlations between median ages of marriage and probability of marriage were negative and generally significant for the 15-19 age group. Among the older age groups coefficients were generally positive. There was some evidence of an association between probability of marriage and sex ratio in any group of potential mates. The effect appeared more marked among 15- to 19-year-old females. Local factors which might explain at least part of the decline in nuptiality for the greater part of the period under study include the decline in the fishing industry and the 'land hunger' which existed until the late 1920s. This decline is interpreted as a 'Malthusian' response to economic and social conditions, but it coexisted with a 'neo-Malthusian' strategy, in the shape of declining marital fertility. The 'Malthusian' strategy seems to have been largely abandoned around the 1950s, but it may have reappeared during the 1980s.

Adolescent↗
PubMed1977

Migration, culture and mental health.

The former belief that immigrants always suffer from an excess of mental disorder is no longer valid, and the old rivalry between social selection and social causation hypotheses has lost much of its relevance. The mental health of a migrant group is determined by factors relating to the society of origin, factors relating to the migration itself, and factors operating in the society of resettlement; and all three sets need to be considered if one seeks to reduce or merely to understand the level of mental disorder in any immigrant group. Illustrations from each set of factors are presented, with indications of whether they appear to have general relevance or be related to specific mental disorders.

Alcoholism↗
PubMed2004

Social adversity contributes to high morbidity in psychoses in immigrants--a national cohort study in two generations of Swedish residents.

BACKGROUND: Recent reports have indicated that immigrants have an elevated risk of schizophrenia as well as an increasing tendency for social exclusion. The aim of this study was to compare rates of schizophrenia and other psychoses in immigrants and their children of different ethnic groups with the majority population in Sweden in relation to social adversity. METHOD: The study population consists of a national cohort of 1.47 million adults (born 1929-1965) and 1.16 million children and youth (born 1968-1979) in family households from the national census of 1985. Multivariate Cox regression analyses was used to study hospital discharge data during 1991-2000 in relation to socio-economic household indicators from 1985 and 1990 (single adult household, adults having received social welfare, parental unemployment, urban residency, housing and socio-economic status). RESULTS: First as well as second generation immigrants had higher age and sex adjusted risk ratios for schizophrenia as well as for other psychoses (RRs 1.4-3.1 and 1.0-2.0 respectively) compared with the Swedish majority population. These risk ratios decreased considerably after adjusting for socio-economic indicators, for all groups, but particularly for the non-European immigrants. However, an elevated risk still remained in the Finnish and Eastern and Southern European study groups. CONCLUSIONS: A higher risk of schizophrenia and psychoses was found in two generations of immigrants of diverse ethnicity. The results indicate that social adversity contributes to the higher risk.

Adolescent↗
PubMed1997

Psychological distress among British South Asians: the contribution of stressful situations and subcultural differences in the West of Scotland Twenty-07 Study.

BACKGROUND: This paper seeks to explain an excess of psychological distress previously found among groups of British South Asians (with ancestry from the Indian subcontinent) living in Glasgow, compared with the general population. The excess was found on a psychosomatic measure and a measure of self-assessed distress but not on a clinically validated measure (the General Health Questionnaire or GHQ). The paper investigates whether South Asians are subject to stressful situations to which the GHQ is less sensitive than the other two measures. METHODS: Random samples of 159 South Asians aged 30-40, mean age 35, and 319 from the general population, all aged 35, were interviewed in Glasgow, using the 12-item General Health Questionnaire (GHQ-12), a psychosomatic symptom scale (PSS) and a self-assessment of distress. Subcultural groupings were differentiated by South Asian origin, English fluency, religion, and gender. Stressful situations assessed were experience of assault, stress/dissatisfaction with work, overcrowding, low standard of living, absence of family and absence of confidants. RESULTS: The GHQ-12 was less sensitive to certain stressful situations than the other two measures. The PSS and/or self-assessed distress were more sensitive to low standard of living, self-rated stress in work around the house and possibly experience of assault. In a combined analysis, the relation between distress on the PSS or self-assessed measure and subcultural groupings became nonsignificant, while the relation between distress and key stressful situations remained significant. CONCLUSIONS: The greater distress of women, Muslims and limited English speakers is largely explained by the stressful situations they experience. The GHQ-12 under-estimates distress related to situations experienced particularly by ethnic minorities and by women.

Adult↗
PubMed1981

The public finance of medical and dental care in Newfoundland--some historical and economic considerations.

The article discusses the evolution of Newfoundland's health care system from the turn of the century to the present. During this time there were considerable changes in social conditions, political arrangements and the availability of public monies, all of which influenced the structure of the health care sector. In general terms, Newfoundland's health care system shifted from one involving low expenditures and many British type institutions to one involving high expenditures and American type institutions. The evidence suggests that the changes have been particularly beneficial for Newfoundland's merchant class, including the doctors and dentists, although some benefits have also accrued to patients and fishermen.

Financing, Government↗
PubMed2001

From logical neurons to poetic embodiments of mind: Warren S. McCulloch's project in neuroscience.

After more than half a century of eclipse, the mind (in contradistinction to brain and behavior) emerged in the 1950s as a legitimate object of experimental and quantitative research in natural science. This paper argues that the neural nets project of Warren S. McCulloch, in frequent collaboration with Walter Pitts, spearheaded this cognitivist turn in the 1940s. Viewing the project as a spiritual and poetic quest for the transcendental logos, as well as culturally situated epistemology, the paper focuses on McCulloch's and Pitts' efforts of logical modeling of the mind and on the social conditions that shaped that mission. From McCulloch's "experimental epistemology," the mind - purposes that ideas - emerged out of the regularities of neuronal interactions, or nets. That science of mind thus became a science of signals based on binary logic with clearly defined units of perception and precise rules of formation and transformation for representing mental states. Aimed at bridging the gulf between body and mind (matter and form) and the technical gulf between things man-made and things begotten, neural nets also laid the foundation for the field of artificial intelligence. Thus this paper also situates McCulloch;'s work within a larger historical trend, when cybernetics, information theory, systems theories, and electronic computers were coalescing into a new science of communication and control with enormous potential for industrial automation and military power in the Cold War era. McCulloch's modeling the mind as a system of command and control contributed to the actualization of this potential.

Brain↗
PubMed2005

Comparable "risks" at the socioeconomic status extremes: preadolescents' perceptions of parenting.

This study was focused on contextual variations in the parenting dimensions salient for preadolescent adjustment. The sample consisted of 614 sixth graders from two communities, one low and the other high income. Parenting dimensions included those known to be significant in each socioeconomic context: isolation from parents (emotional and physical), and parents' emphasis on achievements (overall expectations and emphasis on integrity over success). Adjustment outcomes included subjective well-being as well as school competence. Contradicting stereotypes, results showed that on average, very affluent children can perceive their parents as emotionally and physically unavailable to the same degree that youth in serious poverty do. The ramifications for adjustment also seem to be largely similar: Closeness to parents was beneficial for all, just as criticism was deleterious. Even after considering the quality of parent-child relationships, parents' physical absence (e.g., at dinner) connoted vulnerability for distress and for poor school performance in both groups. The connotations of a few parenting dimensions varied by context and gender; these variations are discussed as are overall implications for future research and practice.

Adult↗