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Over the past two decades, cochlear implantation has become a widely accepted treatment of deafness in children. Over 20,000 children have received cochlear implants worldwide. Hearing, language and social development outcomes have been positive. We review current issues in cochlear implantation, candidacy, evaluation, surgery, habilitation, ethics and outcomes.
With more than 22 million inhabitants, Uzbekistan is the most populous of the Central Asian republics of the former USSR. Using data from a retrospective survey conducted in 1992 among women of reproductive age, the paper examines fertility trends and determinants during the twentieth century. The analysis shows that the absence of a government-supported birth control programme and the strong pro-natalist policies of the Soviet authorities during most of the century did not affect either the onset, nor the progress of the fertility transition. The results indicate, however, that the social development programmes undertaken by the Soviet government did play a very active part in the transition as shown by the impact of education on reproductive behaviour, as well as on the very specific contraceptive mix adopted by the population after the mid-1970s.
PRIMARY OBJECTIVE: This article presents data on the secular trend in age at menarche for 1955 women from 16 to 76 years of age born between 1920 and 1979 and studied under the Nutrition and Health Survey conducted in the municipality of Rio de Janeiro, Brazil, in 1996. METHODS AND PROCEDURES: Age at menarche was defined by the retrospective method. Women were grouped according to decade of birth, and the trend was estimated using simple linear regression between age at menarche and year of birth for the following specific periods: 1920-1940, 1920-1960, 1960-1979 and 1920-1979. MAIN OUTCOMES AND RESULTS: Mean age at menarche decreased from 13.07 to 12.40 years when comparing the group of women born in the 1920s with the 1970s birth cohort, corresponding to a mean rate of -0.0123 years per year (p < 0.001). The downward trend was -0.0120 years per year (p > 0.05) for the 1920s, 30s and 40s, -0.0093 years per year (p < 0.05) for the period from 1920 to 1960, and -0.0224 years per year (p < 0.01) for the 1960s/70s. CONCLUSIONS: The results suggest a secular trend in age at menarche. The literature points to such environmental variables as improved living conditions and expanded access to health services. Within this context, age at menarche could be used as a marker for social development.
The Medicare Hospice Benefit has served terminally ill persons and their families since 1983. The political and social development of this policy combined both humanitarian and cost-saving strategies. Although this federal hospice program has mainstreamed care of the terminally ill and provided multiple services, four major constraints of the benefit package are identified and explored. As the United States draws closer to health care reform, it is important that we analyze this policy before we devise new ways to care for the dying and their families.
The Second Cambridge Population Infant Vision Screening Programme using the VPR-1 videorefractor without cycloplegia was undertaken in order to identify those infants with refractive errors who were potentially amblyogenic or strabismogenic. Infants identified at eight months were entered into a control trial of treatment with partial spectacle correction and underwent a long-term follow-up that monitored a wide range of visual, visuoperceptual, visuocognitive, visuomotor, linguistic and social development. In the present paper, the authors report on the outcome measures of visual acuity and strabismus. Poor acuity was defined as a best-corrected acuity of 6/12 or worse on crowded letters or 6/9 or worse on single letters, at age 4 years. Acuity was measured in 79 infants who were significantly hyperopic and/or anisometropic at 11-12 months of age, 23 who showed hyperopia of +3D but less than +3.5D, 196 control subjects, 14 controls with refractive errors, and 126 others who showed an accommodative lag on screening but were not significantly hyperopic on first retinoscopy. There was a poorer acuity outcome in the untreated group of hyperopes compared to controls (p < 0.0001) and to the children who were compliant in spectacle wear (p < 0.001) or who were prescribed spectacles (p < 0.05). Children who were significantly hyperopic at eight months were also more likely to be strabismic by 5.5 years compared to the emmetropic control group (p < 0.001). However, the present study did not find a significant difference in the incidence of strabismus between corrected and uncorrected hyperopic infants. Children who were not refractively corrected for significant hyperopia were four times more likely to have poor acuity at 5.5 years than infants who wore their hyperopic correction, supporting the findings of the First Cambridge Population Infant Vision Screening Programme.
Recently, large increases have been noted in injection drug use and HIV prevalence among drug users in Indonesia. The objective of this study was to examine the experience of drug users with HIV testing in Bali, Indonesia. In-depth interviews were conducted with a sample of 40 drug users who had injected heroin in the Denpasar, Bali area. The users' experience with testing highlighted the importance of pre- and post-test counselling that provides clear information, confidentiality and assistance in developing social support.
Great progress has been made in the international protection of human rights since 10 December 1948 (when the United Nations General Assembly adopted the Universal Declaration of Human Rights). Amidst the doom and gloom of the media's reporting of current affairs, it is easy to overlook this progress. This article provides a definition of 'human rights' and examines early human rights campaigns. It then considers the areas of progress: human rights are now part of the international political vocabulary, there is a recognition that respect for human rights can assist a country's economic and social development, there has been a growth of human rights treaties and techniques and non-governmental organizations (NGOs) see protecting human rights as a major activity. State sovereignty has been eroded as national governments are being held accountable to the international community for their human rights policies. A new challenge is to ensure respect for human rights by non-state entities, such as transnational corporations. The growing culture of international protection of human rights is here to stay. This is not a reason for complacency, but it is a sign of hope.
Now that genetic inheritance is featuring more and more as an explanation of disease and human behaviour in general, a question that needs to be asked is how such explanations affect people's perceptions of family and kinship and to what extent genetic explanations conflict with broader social developments. Ideas about the genetic inheritance of disease place the family and kin group in the spotlight, requiring all its members to be scrutinised. Research on inheritable diseases entails a medicalization of kinship that reflects and promotes a view of family relationships at odds with the ongoing changes in the structure of families. At a time when family structures are more fluid and less determined by "blood" relationships than ever before we have an increasing emphasis on genetic inheritance as the transmitter of both human behaviour and kinship. Embedded in concepts of genetic inheritance is thus the notion that family and kin are the medium through which inheritance flows. Two cases from an anthropological study will illustrate how genetic mapping leads to the medicalization of kinship.
AIMS: Although unintentional injuries are recognised as a major public health problem globally, little is known about their patterns and rates at the community level in most low-income countries. Rapid social development, leading to increased traffic and industrialization, may be changing patterns of injury. Injuries within the home environment have not so far been recognized to the same extent as traffic and work-related injuries in Vietnam, largely because they have not been effectively counted. This study took place in northern Vietnam, in the context of a longitudinal community surveillance site called FilaBavi, as a pilot project aiming to determine the community incidence of unintentional injury and to explore appropriate methods for community-based injury surveillance. METHODS: An initial study population of 23,807 was identified and asked about their experience of injury in the preceding three months. RESULTS: Overall 450 new injuries were detected over 5,952 person-years, a rate of 76 per 1,000 person-years. Males were injured at 1.6 times the rate of females, and home and road traffic accidents were most common. Most injuries occurred during unpaid household tasks. Cutting and crushing injuries occurred most frequently. Of 221 deaths from all causes in the FilaBavi population during 1999 among 43,444 person-years, 25 were attributed to unintentional injuries and two to suicide. Unintentional injury was the third leading cause of death in this community, with a case-fatality rate of 0.8%. DISCUSSION: The findings suggest that greater attention needs to be directed toward the prevention of injuries occurring in the home in rural Vietnam. On the basis of this pilot study, a one-year study using the same approach is under way to characterize the patterns of unintentional injury in more detail, including any seasonal variation.
It was long believed that central arrows needed to be spatially predictive to produce a shift in spatial attention. Recent evidence indicates, however, that central spatially nonpredictive directional cues, like arrows, will trigger reflexive shifts in attention. We asked what this recent discovery means for past studies that used predictive directional cues such as arrows. Our findings indicate that predictive arrows produce attention effects that greatly exceed the individual or summed effects of reflexive orienting to nonpredictive arrows and volitional orienting to predictive numbers. This suggests that the especially large effect produced by predictive arrows reflects an interaction between reflexive and volitional orienting. Given the broad application of the predictive arrow cueing paradigm in both past and current research, the present data shed new light on a wide range of investigations, from psychophysical studies of basic attention to behavioural and neuroimaging studies of cognition and social development.
Some members of the so-called virtual world deny that technology such as the virtual environment (VE) is value-laden. But there are a variety of complex issues which arise in VE that make it necessary to think about ethics and values in VE applications. Using VE in therapy and psychotherapy research or diagnostics leads to several ethical concerns. VE can impoverish those aspects of life that are essential to social development, interpersonal relations, and emotional growth. This paper will focus on the concept called "virtual world," a question of metaphysics. After reviewing general ethical principles, ethics in applied sciences will be described. Ethical decision-making, code of conduct, and specific issues in VE will be discussed. The VE community is challenged to set guidelines around VE, and its ethics and values. A set of measurement tools around ethical codes and values in a virtual world ought to be discursively gained in this virtual world and in real society as a whole.
BACKGROUND AND PURPOSE: Childhood-onset schizophrenia (COS) is a clinically severe form of schizophrenia, which causes severe impairment to cognitive, linguistic, and social development. There are few prospective and retrospective open clinical trials of risperidone and olanzapine in COS. In this open-label, randomized, prospective study, we compared the tolerability and effectiveness of risperidone versus olanzapine in the treatment of COS patients. METHODS: The study population consisted of 25 children with COS (mean age 11.09 +/- 1.55 years). After an evaluation, patients received risperidone (0.25-4.5 mg/day, mean dose 1.62 +/- 1.02 mg/day) or olanzapine (2.5-20 mg/day, mean dose 8.18 +/- 4.41 mg/day) for 12 weeks, with weekly evaluations. RESULTS: Both groups showed comparable significant (p < 0.001) within-group improvement from baseline to endpoint (LOCF) in Positive and Negative Symptoms Scale (PANSS) total and subscale scores. Of the olanzapine-treated children, 11 (91.7%) completed the 12 weeks of the study, whereas in the risperidone-treated children only 9 (69.2%) did. No significant differences between risperidone-treated children and olanzapine-treated children were observed on Barnes Akathisia Rating Scale (BAS) and Simpson-Angus Scale (SAS) rating scales. Both treatment groups showed significant (p < 0.001) increase in weight from baseline to endpoint. CONCLUSION: Our open-label, small-scale comparative study suggests that both risperidone and olanzapine appear to be efficacious antipsychotic medications in COS, with a slight nonsignificant advantage of olanzapine in the dropout rate.
The cultural and environmental factors affecting the food quest and nutritional status of the Moshaweng Tlokwa, a Tswana agro-pastoral society occupying the semi-arid eastern Kalahari Desert of Botswana, are examined. Data are presented on methods of food procurement, storage, preparation, and preservation. Tlokwa diet is based on agriculture horticulture and animal husbandry but a surprising number of wild species are regularly used as food. This pattern is nutritionally protective and viewed by the author as a principal reason for Tlokwa dietary success in their semi-arid environment. Data are presented on food habits, dietary prohibitions, and characteristic diets of infants, children, adolescents, and adults. Many Tlokwa foods are encouraged or prohibited on the basis of the consumers age, sex, and social development. Such patterns reduce competition for dietary resources, assure a more equitable distribution of food, and sustain the nutritional quality of diet. During 1973 to 1975 the Tlokwa appeared healthy and well fed; heavy rain-fall had just broken a 7-year drought. Kwashiorkormarasmus, avitaminosis, or other classical signs of malnutrition were not observed. A trend towards bottle feeding was noted. Children and adolescents are rapidly losing their ability to identify edible wild food resources. The author concludes that the Tlokwa heretofore have coped satisfactorily with drought in their semi-arid territory and recommends continued diversification of their food quest. Diversity is viewed as essential if the Tlokwa are to maintain their nutritional well-being in coming decades.
The purpose of this study was to determine factors affecting retirement migration of older persons, using Haas and Serow's (1993) model as the framework. Data were based on 462 persons aged 50 and older who had migrated to Idaho and surrendered their out-of-state drivers' licenses during 1992 and 1993. Most moved from another state in the west and were motivated to move to Idaho by such factors as outdoor recreation and quality and pace of life. They had visited their new community at least five times before moving and developed social ties quickly upon arriving. Businesses and community planners can more effectively anticipate changes necessary to accommodate older migrants to their community.
This study of the caregiving arrangements of 214 disabled elderly people in a large northeastern city found that the recipients of care were severely disabled, particularly in instrumental activities of daily living, yet had limited sources of informal care and used formal services minimally. The authors discuss the need to use a structural adaptation approach and to develop social services that are culturally sensitive and acceptable to both elders and their caregivers.
BACKGROUND: The aim of this cohort study was to evaluate the relationship between psychosocial job demands and job control during pregnancy and risk of small-for-gestational age (SGA) and preterm delivery. METHODS: We studied 8711 Danish women with singleton pregnancies between 1989 and 1991. Information about medical and obstetric history, general psychosocial and lifestyle factors and occupational exposures were collected at 16 weeks gestation. The analyses were restricted to 3503 respondents who worked at least 30 hours per week during the first trimester. The women's scores on both the job demand and job control questionnaire were initially dichotomized at the median score, and combined into four exposure categories: relaxed jobs (low demands and high control), active jobs (high demands and high control), passive jobs (low demands and low control), and high-strain jobs (high demands and low control). RESULTS: After adjustment for confounders, women with relaxed jobs had the lowest risk of SGA and preterm delivery. Compared to this group the odds ratio (OR) for SGA delivery among women with passive jobs was 1.3 (95% confidence interval [CI]: 0.9-1.9), with high-strain jobs 1.1 (95% CI: 0.7-1.6), and with active jobs 1.1 (95% CI: 0.8-1.7). Compared to women with relaxed jobs, the OR for preterm delivery among women with passive jobs was 1.4 (95% CI: 0.8-2.3), high-strain jobs 1.3 (95% CI: 0.7-2.2) and active jobs 1.2 (95% CI: 0.7-2.2). All risks were consistently increased in women with low job control. The risks were higher for preterm than for SGA deliveries. However, none of the findings were statistically significant. CONCLUSIONS: The influence of work-related psychosocial strain on the risk of SGA and preterm delivery seems to be small in countries with highly developed social support systems and few other work-related hazards.
Four characteristics have been identified that affect the contemporary analysis of cause of death: (1) the increasing use of cause-of-death data for public policy; (2) the growing disjuncture between cause of death and cause of poor health; (3) the problem of specifying cause of death for the elderly, who constitute a growing proportion of the population and, accordingly, of mortality; and (4) the impact of technology and medical science on the temporal comparability of mortality statistics. With regard to the first issue, statistical data in general are being used with increasing sophistication throughout society. The public is exposed to all types of data by the media,and is increasingly educated in how to interpret statistics. Government at all levels increasingly uses data to help to help identify priorities, to choose among policy options, and to evaluate outcomes of decision making. Cause-of-death data are but a specific subset of information that are being used to understand social, economic, and health issues and to make more informed private and public choices regarding these issues. Increasing use of any data set is likely to result in better data simply because greater use results in closer scrutiny of data quality with resultant emphasis on evaluation and systematic efforts to improve quality. This is happening to cause-of-death data in the United States. The National Center for Health Statistics (NCHS) initiated major efforts through two national workshops in 1989 and 1991 to improve the quality of medical certification of death through better training of physicians, medical examiners, and coroners. While there is no clear evidence that the initiatives resulting from these workshops alone resulted in data quality improvement, the indicators used by NCHS to measure quality of medical certification point to continued gradual improvement in completeness and specificity in cause-of-death data. The gap between causes of morbidity and causes of mortality is growing because advances in medical science has essentially eliminated many infectious and communicable diseases that previously caused premature death and have considerably reduced the lethality of chronic conditions that previously caused death at earlier ages. As acute conditions have moved into the background, so to speak, a variety of disabilities and impairments have moved forward as sources of illness,pain, and diminished quality of life. As a consequence, the previously clear etching in mortality statistics of a society's health has become blurred by advances in medicine, healthcare, and prevention. Mortality data continue to have value per set and are important to social and medical knowledge because of their availability as a uniquely continuous data set. However, increasingly, a complete and contemporary profile of the health of a society requires data on both morbidity and mortality as complimentary indicators of health and social development. Not only do we need to know of what causes people to die, but also what health conditions aggravate and diminish their lives and, at an aggregate level, that conditions impose the greatest health costs on the community. Increasingly, these are debilitating conditions of the elderly that may diminish life but may not cause death. Medical description of the cause of death of an elderly person has probably never been easy; however, the contemporary extension of life has made the problem more visible and substantial than in earlier times. It is likely that the relatively few octogenarians of centuries past were also afflicted by concurrent medical conditions, and that even younger persons were prematurely afflicted by conditions that are now identified with advanced age. For these population groups, the description of cause of death, as a single and singular initiating event, is problematic.
Elder self-neglect is the most common form of elder mistreatment. Individuals who cannot provide basic needs for themselves may develop social, functional, and physical deficits. The systematic characterization of self-neglecting individuals is the goal of the Consortium for Research in Elder Self-Neglect of Texas project. This study reports on the nutritional status of self-neglecting elderly. Self-neglectors (SN) were recruited based on referrals along with matched control (CN) subjects. Data are for 40 SN subjects (age 76 +/- 7 y) and 40 CN subjects (76 +/- 7 y). Blood samples were collected and analyzed for indices of nutritional status. SN subjects had a greater serum concentration of total homocysteine than CN subjects (13.6 +/- 4.5 vs. 11.6 +/- 5.6 micromol/L, P < 0.05) and a lower concentration of red blood cell folate (1380 +/- 514 vs. 1792 +/- 793 nmol/L, P < 0.05). Plasma beta-carotene and alpha-tocopherol were lower in SN subjects (0.28 +/- 0.2 vs. 0.43 +/- 0.33 micromol/L; 23.2 +/- 9.3 vs. 27.8 +/- 9.3 micromol/L, P < 0.05). SN subjects had a lower serum concentration of 25-hydroxyvitamin D than CN subjects (33.7 +/- 16.4 vs. 44.1 +/- 19.6 nmol/L, P < 0.05). These differences in markers of nutritional status show that the self-neglecting elderly are at risk for altered nutritional status, particularly of folate, antioxidants, and vitamin D. Evaluation of these data in relation to other functional and cognitive assessments are critical for evaluating the relation between nutrition and self-neglect.