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PubMedDate not supplied

The prolonged epidemic of anthroponotic cutaneous leishmaniasis in Kabul, Afghanistan: 'bringing down the neighbourhood'.

In order to investigate the distribution and causes of the spread of anthroponotic cutaneous leishmaniasis (ACL) in Kabul, Afghanistan, a cross-sectional study was conducted during 1997-98 amongst 75,787 residents in the 13 central districts of the city. Using data on active lesions and scars with their times of onset, migration patterns and age of subjects, 2 independent methods were used to estimate, retrospectively, the annual incidence of ACL in recent years. Results indicated a rapid increase in incidence from 1987, peaking in 1996 when an estimated 12% of the population had active disease. Active prevalence was lowest in infants (aged < 2 years), and while risk was gender-independent in children and adolescents, active prevalence in those aged > 20 years was significantly higher amongst females than males (odds ratio [OR] = 1.51, 95% CI 1.34-1.70). About 44% of lesions were located on the head, 38% on upper limbs, 16% on lower limbs and 2% elsewhere. The relative frequency of head lesions dropped with age (P < 0.001), and amongst adults was lowest amongst males (P < 0.001), possibly due to the protective effect of a beard. Within the study population, 32% reported that they had immigrated from outside Kabul, 34% that they had been born in Kabul but had since migrated to another district of the city, and 34% that they had been born in the district of their present residence. Active prevalence amongst those born in their current district of residence was positively associated with the percentage of immigrants in their district (P = 0.027), indicating that a 1% increase in the percentage of immigrants increased the odds of an active lesion by 12% (OR = 1.12, 95% CI 1.01-1.24), but there was no association with the percentage of migrants from other districts in Kabul (P = 0.65) or with war damage (P = 0.33). As active prevalence was not significantly greater in immigrants than local Kabulis, these results support the hypothesis that the epidemic in Kabul has been maintained by a steady influx of susceptible immigrants. It is important that the new opportunities for social development that now exist in Kabul are not hampered by this unpleasant and stigmatizing disease. As population movement is clearly a contributing factor to its transmission, this threat is very real.

Adolescent↗
PubMed1999

Hearing screening--aspects of epidemiology and identification of hearing impaired children.

Mass screening of hearing in children is based on the concept of secondary prevention. In recognition of the importance of an early identification and intervention in children with congenital or early-acquired (i.e. neonatal period) hearing disability, numerous hearing screening programs have been introduced throughout the world. The devastating consequences of a congenital/early acquired hearing disability upon the speech, language, and social development of a child, and the estimated prevalence rates of at least 1-1.5/1000 live births of congenital permanent hearing impairment, represent an important health problem. The increase in the estimated prevalence of permanent hearing impairment in childhood, reaching at least 3.6-8.2% of live births at 5-9 years of age further emphasizes the importance of the problem. The delayed identification of children with congenital/early acquired hearing disability should result in the implementation of universal neonatal hearing screening, and the negative impact on the learning processes during school age from hearing impairment acquired throughout childhood seems to justify the introduction or maintenance of a hearing screening at school entrance. Implementation of efficient hearing screening programs throughout the neonatal period, infancy, or childhood should result in secondary prevention of this important health problem.

Child↗
PubMed1997

Canine communication.

Communication occurs when one individual, the sender, produces a signal that alters the behavior of another individual, the receiver. The signal can provide broadcast information about species and individual identity or transmitted information, in which the sender effects a change in the receiver's behavior. To reduce ambiguity, signals have evolved to be conspicuous, redundant, and stereotypic. These features allow communication signals to be produced by senders and perceived and acted upon appropriately by receivers, both conspecific and heterospecific. The modality of the communication signal can be visual, olfactory, or acoustic. Visual signals can be adjusted rapidly for response during interactions between individuals at close or medium range. Examples include displays of relative dominance or submission. Olfactory signals can be used for individual, sex, or group identity at close range during greetings and assessments of individuals. Excretory products can be used for olfactory communication over long distances and for long periods of time. Acoustic signals can be adjusted rapidly for close- and far-range communication. They do not persist in the environment. For dogs, communication is fundamental to maintaining affiliations, reducing competition, and identifying individuals. These factors are critical to the highly developed social behavior of dogs. In an ultimate sense, dogs have been selectively bred for positive interactions with humans; in a proximate sense, many dogs spend their lives in close social association with humans. For these reasons, many of the signals used by dogs in dog-dog communication are also used in dog-human communication. Veterinarians act as receivers for communication signals when greeting dogs as patients. The information obtained is used to assess the state of arousal and probability of future behavior of the dog so that handling of the animal can be facilitated. The goals are to minimize stress and injury, to successfully complete the treatment program, and to promote the health of the animal.

Animal Communication↗
PubMed1985

Adventure, Etc.--a health-promotion program for chronically ill and disabled youth.

Adolescents with a chronic illness or physical disability have a more difficult time separating from parents, achieving a sense of mastery, developing social skills among peers, and achieving a positive body-image than do able-bodied adolescents. To promote attainment of these developmental tasks, Adventure, Etc. was created as a wilderness/urban Outward Bound experience for chronically ill, physically disabled, and able-bodied teens. Pre- and posttesting and interviewing assessed locus of control, self-image, family environment, and family dynamics. Over a two-year period, 37 teens completed the program and were tested; 23 were chronically ill or disabled. The chronically ill/disabled group showed a significant increase in internal locus of control. No change was found in the able-bodied group. Both the able-bodied and the disabled/chronically ill groups showed a significant improvement in body image. Reported family conflict declined, as did family recreational involvement, while individual recreational activities among these adolescents increased. Based on these results, new follow-up activities for the parents and adolescents were initiated to further the gains of program participants.

Adolescent↗
PubMedDate not supplied

Perceived job satisfaction factors of nursing assistants employed in Midwest nursing homes.

The purpose of this study was to determine the perceptions of nursing assistants employed in Midwest nursing homes in relation to job satisfaction. The study population included 283 nursing assistants employed in 24 nursing homes. An analysis of frequencies using chi square at the .05 level of significance was used to examine the significance of the responses. Study results indicated the nursing assistants were most concerned with the security of their jobs, the potential within their jobs for growth and development, socialization, and challenge in their work.

Adolescent↗
PubMed2001

The impact of AIDS, immigration and housing overcrowding on tuberculosis deaths in São Paulo, Brazil, 1994-1998.

The objective of this paper was to describe the distribution of tuberculosis (TB) mortality by area in the municipality of São Paulo, Brazil, from 1994 to 1998, and to evaluate its statistical association with several population characteristics. We surveyed TB deaths grouped by residential area, at the district level, and we calculated the rates for these areas standardized by gender and age groups. We applied simultaneous autoregressive--SAR regression analysis (autocorrelated errors model) in order to fit a "stepwise" model correlating TB deaths with the variables of interest. Significant associations were found between TB mortality rates and AIDS mortality rates, overcrowding at the household level, social development (expressed by a socioeconomic index), and rates of foreign immigration and immigration from other Brazilian States. Regression analysis allowed us to estimate the frequency of TB deaths virtually attributable to co-infection with HIV at 22.37% (95% confidence interval: 12.15-41.17%). TB death rates and utilization of public health services were not statistically associated, suggesting a reduced effectiveness of programs directed at control of the disease. The correlation between TB death rates and deprivation, measured by the socioeconomic index, indicates higher mortality in underprivileged areas. The significance of the association between housing overcrowding and TB deaths, in contrast to the absence of association with district-level overcrowding, indicates that prolonged contact is needed for disease transmission. Although the influx of foreigners and national migrants to the city diminished after the 1980s, immigration rates have been significantly correlated with TB mortality, suggesting greater vulnerability of these population segments to the disease.

AIDS-Related Opportunistic Infections↗
PubMed2002

Pneumoobstruction of the tracheobronchial tree as a hypothetical cause of balbuties.

The occurrence of balbuties is a common phenomenon. Balbuties is defined as frequent repetition and lengthening of syllables and words, alternatively frequent halting with pauses impairing the rhythmic flow of speech. Balbuties may have a negative influence upon the psychic as well as social development of an individual. Psychiatric co-morbidity of balbuties usually includes some other defects in behaviour, such as states of anxiety, depression, etc. The ethiology of balbuties has not yet been discovered, neither its casual therapy is possible. The phonating apparatus is formed by: the lungs with the trachea, the larynx, and the vocal tract. The source of the expired air flow is given by the expiring lungs. In balbuties the fatal defect probably results from a pneumoobstruction of the tracheobronchial tree in the peripheral respiratory passages. The present paper gives a hypothetical explanation of the cause.

Bronchi↗
PubMed2003

Recovery from opioid addiction in DATOS.

Patient attributions for their own long-term recovery were obtained in a 5-year followup of 432 admissions to 18 outpatient methadone treatment programs. Subjects were classified into two groups - recovering and non-recovering-strictly defined and based on both biological and self-report measures of no opioid or cocaine use, less than daily use of alcohol, and no arrests or illegal activity during the year prior to interview. The 28% who were in recovery at Year 5 reported that they had relied primarily upon personal motivation, treatment experiences, religion/spirituality, family, and their job/career. Particular value was placed on the support from family and close friends, indicating the importance of stronger efforts to develop social networks for support of drug-free functioning, especially among patients who lack these resources or need them strengthened. More information is available on the Internet at www.ibr.tcu.edu.

Adult↗
PubMedDate not supplied

Educational intervention strategies for children with visual impairments with emphasis on retinopathy of prematurity.

Young children with retinopathy of prematurity have many intervention needs. This article discusses the possible causes of retinopathy of prematurity and possible educational problems experienced by these children. In addition, possible intervention strategies are suggested in the areas of language development, social interaction, self-help skills, orientation and mobility, and educational technology as they relate to the needs of young children with retinopathy of prematurity.

Child↗
PubMed1998

Treatment of high blood pressure in Germany.

The reunification of Germany has made it possible to compare the health care in two independently developed social structures. The prevalence of hypertension was considerably greater in East German men and women, compared with West German men and women, although salt intake was lower in East Germany than in West Germany. Cardiovascular mortality was correspondingly greater. A centralized public health effort was used in East Germany, whereas in West Germany, the activities were decentralized and to a large extent dependent on private philanthropists. In the last two decades, cardiovascular mortality declined in West German men and women, whereas the same was not true for East German men and women. Hypertension incidence, awareness, treatment, and control have improved slightly in Germany, but not enough to explain the improved morbidity figures. Twenty percent of men and women remain unaware of their hypertension, 40% are aware but not treated, and only half are aware and controlled. Complacency is unjustified in Germany and much needs to be done.

Adult↗
PubMed1989

Long-term results of prosthetic therapy in adult cleft lip alveolus and palate patients.

In the framework of the complex rehabilitation of cleft lip and palate patients the final phase of the dental therapy is attained with the definitive prosthetic treatment. This study comprises 148 prosthetically treated patients in the period 1973 to 1986. The results show that there are good preconditions for an undisturbed professional and social development of the cleft lip and palate patients through intensive dental care.

Adolescent↗
PubMed2003

Sociocultural contexts of adolescent sexual behavior in rural Hanover, Jamaica.

PURPOSE: To investigate sexual behavior of adolescents in rural Hanover, Jamaica, and to elucidate the cultural contexts of this behavior. METHODS: Focus group discussion (FGD) sessions with 73 out-of-school young adolescents aged 15 to 18 years, recruited from health centers, as well as community-based organizations through the Social Development Commission (SDC) in Hanover, a local youth and community development organization, within the Ministry of Local Government, Youth and Community Development. The discussions focused on the adolescents' knowledge of sex and sexual risks, perceived vulnerability to sexual risks, use of protection, self-efficacy, and societal expectations. Data were analyzed, using the content analysis technique. RESULTS: Analyses of transcripts revealed the existence of different sexual scripts for males and females. Whereas females are culturally restrained, abstinence is less desirable for males. Both male and female adolescents expressed the view that the family was an important part of an adolescent's life, and has a strong influence on adolescent sexual behavior. Perception of vulnerability to HIV/AIDS and other sexually transmitted infections, and knowledge of sexual risks among the adolescents was low, and often erroneous. CONCLUSIONS: The results show that sexual attitudes and behavior of adolescents in the study setting are shaped by cultural and gender norms that impose different standards on males and females.

Adolescent↗
PubMed1997

Risky behavior and risk in adolescents with IDDM.

PURPOSE: To determine: (1) the frequency of risky behaviors (alcohol and other drug use, smoking cigarettes, smokeless tobacco use, and unprotected intercourse); (2) the perception of general risks and diabetes-related risks from risky behaviors; (3) if perception of risk is related to engaging in risky behaviors; and (4) if perception of general risks and diabetes-related risks are influenced by age, gender, or race in adolescents with insulin dependent diabetes mellitus (IDDM). Decreasing risky behaviors in youth with IDDM is important because of their increased vulnerability to specific disease related physiologic and pathologic changes. METHODS: A descriptive, cross-sectional design was used. Data on risky behavior and perception of risk were obtained by self-report during a regularly scheduled clinic visit. One hundred and fifty-five adolescents between ages of 10-20 years participated. Correlational and student's t-test analyses were used to test relationships and group differences (age, race, gender). RESULTS: Thirty-nine percent of the sample reported alcohol use, 34% reported smoking cigarettes, 8% reported smokeless tobacco use, 10% reported drug use, and 29% reported unprotected intercourse. Perception of risk to peers from these behaviors was significantly higher (t = 8.1, df 153; p < .001) than risk to self. Females reported significantly lower (t = 3.08, df 52; p < .002) risk to self than males. There was no difference in perception of risk between youth who reported participating in risky behaviors (N = 38%) and those who did not (62%). Not surprisingly, the frequency of risky behavior increased with age (F = 15.46; p < .001). CONCLUSIONS: Compared to community samples of middle school children, our sample had lower rates for most risky behaviors. As with community samples, the physical risks were known and perceived to be higher for peers than self. Perception of risk was not related to self-reports of risky behaviors. The lower rate of risky behaviors might reflect the success of educational efforts directed toward diabetes management or may be due to later initiation of behaviors, especially if personal social development is delayed. Additional research is indicated in order to understand the timing and trajectory of risky behavior and whether or not perception of risk deters youth with IDDM from engaging in risky behavior.

Adolescent↗
PubMed2000

Developmental risk factors for youth violence.

PURPOSE: To replicate earlier research findings on risk factors for youth violence and to explore the effects on violent behavior of constructs shown to increase risk for other problem behaviors, within a developmental frame. METHODS: Data were from the Seattle Social Development Project (SSDP), a prospective study involving a panel of youths followed since 1985. Potential risk factors for violence at age 18 years were measured at ages 10, 14, and 16 years. Bivariate relationships involving risk factor constructs in the individual, family, school, peer and community domains and violence were examined at each age to assess changes in their strength of prediction over time. Attention was also given to the additive strength of increasing numbers of risk factors in the prediction of violence at age 18 years. A final set of analyses explored the extent to which youths were correctly classified as having committed a violent act (or not) at age 18 years on the basis of their overall level of risk at ages 10, 14, and 16 years. RESULTS: At each age, risk factors strongly related to later violence were distributed among the five domains. Ten of 15 risk factors constructs measured at age 10 years were significantly predictive of violence at age 18 years. Twenty of 25 constructs measured at age 14 years and 19 of 21 constructs measured at age 16 years were significantly predictive of later violence. Many constructs predicted violence from more than one developmental point. Hyperactivity (parent rating), low academic performance, peer delinquency, and availability of drugs in the neighborhood predicted violence from ages 10, 14, and 16 years. Analyses of the additive effects of risk factors revealed that youths exposed to multiple risks were notably more likely than others to engage in later violence. The odds for violence of youths exposed to more than five risk factors compared to the odds for violence of youths exposed to fewer than two risk factors at each age were seven times greater at age 10 years, 10 times greater at age 14 years, and nearly 11 times greater at age 16 years. However, despite information gained from all significant risk factors, the overall accuracy in predicting youths who would go on to commit violent acts was limited. CONCLUSIONS: Findings from the study have important implications for preventive intervention programs. Prevention efforts must be comprehensive and developmentally sensitive, responding to large groups or populations exposed to multiple risks.

Adolescent↗
PubMed1989

Characteristics of emigrants from Hawaii.

As part of an ongoing study on young adult psychological and social development, data were obtained through parental reports on the present residences and educational and occupational attainments of 718 present or former residents of Hawaii (average age 31 years). These subjects, as well as their parents, had been tested between 1972 and 1976 on measures of cognitive abilities and personality. The extent of emigration to the mainland in this middle to upper-middle class sample was over 40%. On average, former Hawaii residents now living on the US mainland were of higher intelligence and educational background than their counterparts still living in Hawaii. Differences were also found for number of children, cross-ethnic marriages, and occupational attainment (males only). In addition, parents of US mainland residents scored significantly higher on measures of cognitive abilities and education than parents of current Hawaii residents.

Adult↗
PubMed1992

The intensive care unit. The unfolding ambiguities of survival therapy.

The intensive care unit (ICU), one of the great achievements of modern medicine, is both a set of technologies and a space with a special function. This essay traces the evolution of the ICU's crucial technologies, and how the space bearing this name was carved out in the hospital. Ethical, legal, and social developments, an important part of this story, are incorporated in it.

Adult↗
PubMed2004

Are clinical practice guidelines impartial?

In A Theory of Justice, John Rawls demands from citizens who decide upon principles of justice and the rules derived from such principles that they abstract from all particularities that constitute their identity as unique individuals. This demand is unrealistic in policy settings where actual policy-makers convene to provide guidance, establish rules regarding public good, and enact legislation. In practice, I argue, policy-makers, legislators, and others involved in developing social rules that pertain to distributive justice formulate such rules as reasonably partial spectators. To illustrate, I show how clinical practice guidelines are established and mediated by a reasonably partial expert panel whose partial action is publicly justifiable, yet whose claims to impartiality are not.

Costs and Cost Analysis↗
PubMed2001

Evolution of the mental health care system in Poland.

OBJECTIVE: The aim of this paper is to trace evolution of mental health system in Poland. METHOD: Available Polish literature and fundamental policy documents including mental health legislation are reviewed and major milestones in this evolution identified and then discussed against the background of political and social developments. RESULTS: The mental health system evolved since the beginning of the 1970s from large hospitals towards community-based care. It was found that the changes were rather slow due to financial shortages and lack of clear demand from users. Recent transitions offer opportunities to increase impact of users and their families. On the other hand, however, introduction of health insurance system reduces prospects for well co-ordinated mental health policy and may lead to inequalities in access to services. CONCLUSION: It can be concluded that evolution of mental health services has been influenced by prevailing ideologies as much as by technical and professional considerations.

Health Care Reform↗