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PubMed2003

[The right of the client in geriatric psychiatry to a personal, individual world view. How can we, as caregivers, learn to share this?].

"Validation" after Naomi Feil is the name of a method which is used and recognized the world over as an appreciative way of dealing with the highly aged. Validation is based on universally valid humanist principles. A person is viewed as an individual being having a good reason for his current behavior. This is true for "still oriented" as well as for "non-oriented" persons. It is necessary to recognize and categorize the different behavioral patterns in the various phases of disorientation. Here we speak of the physical and psychological characteristics of the four phases of disorientation. The target group is persons who are just still oriented, but deny their current situation and thus react peculiaryly. The next group is the time and place disoriented persons. Subsequently the group of persons who can express themselves solely by nonverbal means, i.e. repetitive movements, follows. The last group is motionless persons who simply vegetate. In addition, there are suitable verbal and nonverbal techniques that can be used in a most sensible and appreciative way of dealing with these highly aged. The aged persons are not corrected and not oriented according to reality, but are escorted in their world. We call this: "walking in the shoes of the other person". It is necessary to take emotions seriously and to share them with others. We do not take position, we do not judge and we also do not offer hasty solutions. We are honest and do not use well-meant lies. The goal of applying validation is on the one hand the relief and improvement of the work situation of family and the people taking care of these aged persons, and on the other hand a noticeable and measurable increase of these highly aged persons welfare and quality of life.

Aged↗
PubMed2000

Narcissism as a motivational structure: the problem of personal significance.

An understanding of individual life is contingent on understanding not only man's traditional motivations but also the individual strategy for resolving the problem of personal insignificance. Man's sense of personal insignificance comes from two primary experiences: (a) the developmental experience with its increasing awareness of separation and loss, transience, and the sense of lost felt perfectibility; and (b) the increasing cognitive awareness of the immutable laws of biology and the limitations of the self and others in which idealization gives way to painful reality. Each individual seeks narcissistic reparation through the elaboration of a personal narrative or myth, a story, which gives one's life a feeling of personal significance, meaning, and purpose. What is relevant is not the presence or absence of a myth or personal narrative but within which myth one chooses to live one's life. Myths are not explanations rooted in scientific evidence but rather are belief systems lived as if they were truths. Myths provide the individual with a personal sense of identity, and they confirm and affirm memberships in a group or community, and provide guidelines and an idealized set of behaviors within which to operate. Lastly, they may endorse an explanation for the mysterious universe. Three motivational strategies in which the aim is to create a personal myth or personal narrative that ensures a sense of personal significance are described in this article: (a) transcendental or spiritual myths, (b) group or interpersonal myths, and (c) humanistic or personal myths.

Achievement↗
PubMed1999

Use of protease inhibitors among persons with AIDS in Los Angeles County.

We evaluated the access to, and the factors associated with, protease inhibitor use among persons with AIDS in Los Angeles County. A population-based sample of adult persons with AIDS is routinely interviewed in Los Angeles County and includes a 30% random sample of men who have sex with men and all other persons reported with AIDS. Since May of 1996, all participants were asked if their physician had ever prescribed a protease inhibitor for their use. The possible association between protease inhibitor use and sociodemographic, temporal and health care factors was assessed for the 12-month period May 1996 through April 1997. Logistic regression was employed for multivariate analysis. Over the 12-month study period, 61.7% (209/339) persons interviewed reported that their physician had prescribed a protease inhibitor as part of their therapy. In bivariate analysis, treatment with protease inhibitor use was more common for whites (71.4%) and US-born Latinos (68.2%) than blacks (53.4%) and foreign-born Latinos (56.6%), among person of higher income (71.2%) than lower (< $10,000) income (50.3%), in those who reported having insurance (66.7%) than those uninsured (47%) and among persons receiving care at private clinics (86.4%) than at HMOs (63.4%) or public clinics (55.2%). An increasing trend of protease inhibitor use with higher educational level and declining CD4+ count was observed. A temporal increase was noted and this trend was most pronounced for persons receiving care at public clinics. In multivariate analysis, persons receiving care at private facilities (adjusted OR = 2.9, 95% CI 1.0, 8.2) and those with higher incomes (adjusted OR = 2.5, 95% CI 1.5, 4.3), were more likely to report that their physician had prescribed a protease inhibitor. The effect of facility type was modified by time. During the first six months of the study period (May 1996-October 1996) persons with AIDS receiving care at public facilities and HMO sites were substantially less likely to report having been offered a protease inhibitor (adjusted OR = 0.13, 95% CI 0.03, 0.58 and adjusted OR = 0.23, 95% CI 0.05, 1.2, respectively). However, no significant facility-specific differences were observed over the last six-month period (November 1997-April 1997) evaluated. Our findings suggest that substantial differences exist in the prescribing and use of protease inhibitors among persons with AIDS in Los Angeles County. Several factors, including facility of HIV care, calendar time, income, education level and level of immunosuppression were independently associated with protease inhibitor use and suggest the existence of important barriers to access. Efforts should be made to identify and remove barriers that will ensure the widest possible access to protease inhibitors for patients with a clinical indication for their use.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Measurements of personal exposure to nitrogen dioxide in four Mexican cities in 1996.

Nitrogen dioxide is a ubiquitous pollutant in urban areas. Indoor NO2 concentrations are influenced by penetration of outdoor concentrations and by indoor sources. The objectives of this study were to evaluate personal exposure to NO2, taking into account human time-activity patterns in four Mexican cities. Passive filter badges were used for indoor, outdoor, and personal NO2 measurements over 48 hr and indoor workplace measurements over 16 hr. Volunteers completed a questionnaire on exposure factors and a time-activity diary during the sample period. An unpaired t test, an analysis of variance (ANOVA), and a linear regression were performed to compare differences among cities and mean personal NO2 concentrations involving housing characteristics, as well as to determine which variables predicted the personal NO2 concentration. Sampling periods were in April, May, and June 1996 in Mexico City, Guadalajara, Cuernavaca, and Monterrey. All 122 volunteers in the study were working adults, with a mean age of 34 (SD +/- 7.38); 64% were female, and the majority worked in public offices and universities. The highest NO2 concentrations were found in Mexico City (36 ppb for outdoor, 57 ppb for indoor, and 39 ppb for personal concentration) and the lowest in Monterrey (19 ppb for outdoor, 24 ppb for indoor, and 24 ppb for personal concentration). Significant differences in NO2 concentrations were found among the cities in different microenvironments. During the sampling period, volunteers spent 85% of their time indoors. The highest personal NO2 concentration was found when volunteers kept their windows closed (p = 0.03). In the regression model adjusted by city and gender, the best predictors of personal NO2 concentration were outdoor levels and time spent outdoors (R2 = 0.68). These findings suggest that outdoor NO2 concentrations were an important influence on the personal exposure to NO2, due to the specific characteristics and personal behavior of the people in these Mexican cities.

Adult↗
PubMedDate not supplied

The prevalence of personality disorders among those with eating disorders.

The genuine prevalence of personality disorders among those with eating disorders is unknown. However, in this paper, we summarize the existing data, with careful acknowledgment of our approach to interpretation as well as the limitations of previous studies. Our findings indicate that obsessive-compulsive personality is the most common personality disorder in restricting-type anorexia nervosa, while borderline personality is the most common personality disorder in binge-eating/purging type anorexia nervosa. Borderline personality is the most common personality disorder in bulimia nervosa, as well. In those with binge eating disorder, obsessive-compulsive personality is the most common personality disorder although, compared with the preceding eating disorder diagnoses, there are broader clusters of personality disorders represented in this group. We discuss the implications of these findings.

Journal Article↗
PubMed1993

Validation of personal exposure models for sulfate and aerosol strong acidity.

Personal exposure models for sulfates (SO4 =) and aerosol strong acidity (H+) were previously developed using concentration and activity pattern data collected from a personal monitoring study conducted in Uniontown, Pennsylvania, during the summer of 1990. Models were constructed based on time-weighted micro-environmental exposures. For SO4 =, the "best-fit" model included a correction factor, while for H+, it included both a correction factor and a neutralization term. In this paper, we present the validation of these models using data collected in a personal monitoring study conducted in State College, Pennsylvania, during the summer of 1991. Indoor and outdoor concentration and activity pattern data collected in this study were used as inputs for the "best-fit" models for SO4 = and H+. Predicted personal exposures subsequently were compared to the measured personal exposures from State College to determine their accuracy and precision. Predicted personal exposures for both SO4 = and H+ were in excellent agreement with measured personal exposures from State College. The models explained 91 and 62 percent of the variability in personal SO4 = and H+ exposures, respectively, and were able to estimate personal exposures substantially better than outdoor concentrations alone. Validation results suggest that the models' correction and neutralization factors are not site specific and support the models' future application as a technique to assess the personal acid aerosol exposures of children living in similar rural and semi-rural communities.

Acids↗
PubMed2005

Bacterial diarrhea in persons with HIV infection, United States, 1992-2002.

BACKGROUND: To describe trends in bacterial diarrhea among human immunodeficiency virus (HIV)-infected persons during 1992-2002, we examined data from a longitudinal record review study of persons with HIV infection who were receiving medical care in >100 medical facilities in 9 major United States cities. METHODS: An analysis was performed using data from 44,778 persons who were followed up for a mean of 2.6 years. We calculated incidence rates and rate ratios for bacterial diarrhea, by stage of HIV disease, and determined odds ratios (ORs) to compare bacterial diarrhea diagnosis in 2002 versus 1992. RESULTS: The mean annual incidence of bacterial diarrhea was 7.2 cases per 1000 person-years. The incidence of Clostridium difficile-associated diarrhea, the most common bacterial cause of diarrhea, was 4.1 cases per 1000 person-years. Compared with persons without AIDS, persons with AIDS were more likely to have bacterial diarrhea (incidence rate ratio, 1.3-9.9, varying by clinical versus immunologic AIDS and type of bacterial diarrhea). Between 1992 and 2002, the overall rate of bacterial diarrhea in persons with clinical AIDS decreased (OR, 0.4; 95% confidence interval, 0.2-0.6). During the same period, bacterial diarrhea rates among other persons in the analysis did not significantly change. CONCLUSIONS: C. difficile is the most common recognized cause of bacterial diarrhea among persons infected with HIV. The risk for bacterial diarrhea increases with increased severity of HIV disease. Health care professionals should be aware that patients with AIDS are at increased risk for bacterial diarrhea, and they should reinforce recommendations for decreasing the chances of acquiring bacterial diarrhea.

Adolescent↗
PubMed1999

Who in Brazil has a personal doctor?

BACKGROUND: Continued medical care (including having a personal doctor) is regarded as an essential aspect of a good health service. OBJECTIVES: The objectives of the present study were to investigate the reasons for not having a personal doctor, and the satisfaction with the care received by patients with and without a personal doctor. METHODS: We conducted a cross-sectional study with data collected during 20 days over 6 months in the Emergency Service of the Conceição Hospital, the busiest emergency service in Porto Alegre. The subjects were 553 patients selected through systematic random sampling. The main outcome measure was having a personal doctor. Patients who reported usually to see the same doctor and remembered their physician's name were regarded as having a personal doctor. RESULTS: Patients who usually use primary care service represented 23% of the sample, and were four times more likely to have a personal doctor (OR = 3.83, CI 95% = 2.41-6.11). Independent, statistically significant variables associated with having a personal physician were: usually receiving care from a primary health care service (OR = 3.8, CI 95% = 2.39-6.00) and from a physician in the private sector (OR = 2.16, CI 95% = 1.15-4.00). Patients who had a personal doctor reported higher satisfaction with their access to health care. The personal doctors' specialties were: internal medicine (37%), cardiologist (17%), gynaecologist-obstetrician (13%), family physician (8%) and pneumologist (6%). CONCLUSIONS: For patients who attend emergency services in Brazil, primary health care and private medical care provide better access to continuity of patient care. Patients with personal doctors report higher satisfaction with access to consultations.

Adult↗
PubMed2002

Subclinical hypothyroidism is associated with coronary artery disease in older persons.

BACKGROUND: We report the prevalence of coronary artery disease (CAD) associated with subclinical hypothyroidism in older persons. METHODS: We investigated the prevalence of subclinical hypothyroidism and its association with dyslipidemia and with CAD in 170 women and 110 men, mean age 75 +/- 9 years, in an academic nursing home. RESULTS: Of 280 persons, 18 (6%) had subclinical hypothyroidism, 18 (6%) had treated clinical hypothyroidism, 13 (5%) had subclinical hyperthyroidism, and 231 (83%) were euthyroid. Dyslipidemia occurred in 15 of 18 persons (83%) with subclinical hypothyroidism, in nine of 18 persons (50%) treated for hypothyroidism, in six of 13 persons (46%) with subclinical hyperthyroidism, and in 128 of 231 euthyroid persons (55%) (p <.025 comparing subclinical hypothyroidism with euthyroidism and p <.005 comparing subclinical hypothyroidism with treated hypothyroidism and with subclinical hyperthyroidism). CAD was present in 10 of 18 persons (56%) with subclinical hypothyroidism, in nine of 18 persons (50%) with treated hypothyroidism, in 5 of 13 persons (38%) with subclinical hyperthyroidism, and in 38 of 231 euthyroid persons (16%) (p <.001 comparing subclinical hypothyroidism with euthyroidism; p <.005 comparing treated hypothyroidism with euthyroidism; and p <.05 comparing subclinical hyperthyroidism with euthyroidism). CONCLUSIONS: Subclinical hypothyroidism was associated with a high prevalence of dyslipidemia and a high prevalence of CAD.

Aged↗
PubMed1997

Clinical and epidemiologic features of a massive waterborne outbreak of cryptosporidiosis in persons with HIV infection.

During March and April 1993, a massive outbreak of Cryptosporidium infection resulted from contamination of the public water supply in Milwaukee, Wisconsin. The health impact of this outbreak in HIV-infected persons was unknown but was perceived as severe. We surveyed HIV-infected persons who resided in the greater Milwaukee area to examine the acute health impact of cryptosporidiosis on this population. Data from a random-digit dialing survey in the general population residing in the same area were used for comparison. The attack rate of watery diarrhea suggestive of cryptosporidiosis was lower in HIV-infected persons (32%) than in the general population (51%). There was no significant difference in attack rate in HIV-infected persons based on CD4+ T-lymphocyte count. In persons with watery diarrhea, HIV-infected persons were more likely to experience cough (42%), fever (52%), and dehydration (55%). In HIV-infected persons with watery diarrhea, persons with CD4+ T-lymphocyte counts <200/microl had longer duration of diarrhea and were more likely to seek medical attention and be hospitalized. During this massive waterborne outbreak, HIV-infected persons were not more likely to experience symptomatic Cryptosporidium infection than the general population. However, once infected, the duration and severity of illness was greater in HIV-infected persons, especially if the CD4+ T-lymphocyte count was <200/microl.

AIDS-Related Opportunistic Infections↗
PubMed2001

Skills training as an adjunctive treatment for personality disorders.

Personality disorders are usually treated with either psychodynamic or supportive psychotherapy, with psychotropic medication often used as an adjunctive treatment. However, patients with personality disorders pose special treatment issues, because their problems are pervasive and long-standing and they have entrenched deficits in many areas of functioning. In this article, the authors consider the role of skills training in the treatment of personality disorders. They describe a two-pronged approach to the treatment of personality disorders based on a model of deficit compensation. Because skills training has only been investigated in a very limited way in personality disorders, the authors first review research on the use of skills training in Axis I disorders as background for a discussion of ways in which skills training may be applicable to the treatment of Axis II disorders. They describe a number of skills training approaches (social skills training, anger management, and conversational skills) that can be used for a variety of different Axis I disorders. Skills training approaches that are targeted to specific types of disorders (substance use disorders, schizophrenia, anxiety disorders, adolescent problems) are also described. The authors then review what is known about the use of skills training in borderline personality disorder and avoidant personality disorder, and propose skills training approaches that may be useful for patients with paranoid personality disorder and antisocial personality disorder. Case examples are provided to demonstrate how skills training for personality disorders can be applied in clinical practice.

Journal Article↗
PubMed2006

Development of a framework for person-centred nursing.

UNLABELLED: This paper presents the development and content of a person-centred nursing framework. BACKGROUND AND RATIONALE: Person-centred is a widely used concept in nursing and health care generally, and a range of literature articulates key components of person-centred nursing. This evidence base highlights the links between this approach and previous work on therapeutic caring. METHODS: The framework was developed through an iterative process and involved a series of systematic steps to combine two existing conceptual frameworks derived from empirical studies. The process included the mapping of original conceptual frameworks against the person-centred nursing and caring literature, critical dialogue to develop a combined framework, and focus groups with practitioners and co-researchers in a larger person-centred nursing development and research project to test its face validity. FINDINGS: The person-centred nursing framework comprises four constructs -prerequisites, which focus on the attributes of the nurse; the care environment, which focuses on the context in which care is delivered; person-centred processes, which focus on delivering care through a range of activities; and expected outcomes, which are the results of effective person-centred nursing. The relationship between the constructs suggests that, to deliver person-centred outcomes, account must be taken of the prerequisites and the care environment that are necessary for providing effective care through the care processes. CONCLUSION: The framework described here has been tested in a development and research project in an acute hospital setting. Whilst there is an increasing empirical base for person-centred nursing, as yet little research has been undertaken to determine its outcomes for patients and nurses. The framework developed can be described as a mid-range theory. Further testing of the framework through empirical research is required to establish its utility for nursing practice and research.

Attitude to Health↗
PubMed1984

Effects of antiepileptic drugs and seizure type on operant responding in mentally retarded persons.

The performance of 129 mentally retarded persons was studied on a progressive fixed-ratio schedule of reinforcement. Subjects were selected according to antiepileptic drug (AED) regimen or membership in one of four control groups. The AEDs studied were: phenobarbital (PB); phenytoin (PHT); PB in combination with PHT (PB/PHT); and valproic acid (VPA) in combination with other AEDs . The control groups were: persons without seizure disorders and on no medications (control); persons without seizure disorders, but on the chronic medication thioridazine ( TDZ ); persons with histories of one or more seizures and treatment with PB and/or PHT, but currently on no AEDs ; and, to control for the effects of multiple AEDs , persons on multiple drug regimens (i.e., PB and/or PHT in combination with carbamazepine and/or ethosuximide). Except for the VPA group, response rates per minute were decreased in high intelligence quotient (greater than 40) persons receiving AEDs or with a history of treated seizures. Deficits in responding were particularly marked in persons with partial seizures. Persons on VPA responded at rates comparable with those of the control and TDZ groups, unless they had partial seizures. This effect was independent of seizure frequency and was inversely related to serum level. Persons on PB most frequently exhibited frustration responses during testing, and when these occurred they were rated as being significantly more severe. Persons on PB also most frequently elected to "leave the experiment" and did so primarily for reasons thought to reflect deficits in inhibition. These results suggest that operant tasks can be sensitive to both AED effects and to underlying alterations of function that accompany seizure disorders in the mentally retarded.

Adolescent↗
PubMed2000

Consistency of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease.

OBJECTIVES: To investigate the consistency of physician judgments of treatment consent capacity (competency) for patients with Alzheimer's disease (AD) when specific legal standards (LS) for competency are used, and to identify the LS most clinically relevant to experienced physicians. DESIGN: Control and AD patient participants were videotaped being administered a measure of capacity to consent to medical treatment. Study physicians viewed videotapes of these assessments individually and made competency judgments for each participant under different LS followed by their own personal judgment of competency. SETTING: A university medical center. PARTICIPANTS: Participants were 10 older controls and 21 patients with AD (10 with mild and 11 with moderate AD). Five physicians with experience assessing the competency of AD patients were recruited from the geriatric psychiatry, geriatric medicine, and neurology services of a university medical center. MEASUREMENTS: The 31 participants were videotaped performing on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI). The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Vignette A and B assessments were videotaped separately for each participant (total videotapes for sample = 62). Each study physician viewed each videotaped vignette individually, made judgments under each of the LS (competent or incompetent), and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis. Within participant group, consistency of physician judgments was evaluated across LS and personal judgments using percentage agreement and kappa. Agreement between personal and LS judgments for the AD group was evaluated for each physician using logistic regression. RESULTS: As expected, physicians as a group generally demonstrated very high percentage agreement in their LS and personal competency judgments for the control group. For the AD group, mean percentage judgment agreement among physicians ranged from a high of 84% (LS1) (evidencing a treatment choice) to a low of 67% (LS3) (appreciating consequences of treatment choice). Mean percentage agreement for personal competency judgments was 76%. For the AD sample, kappa analyses for physicians as a group demonstrated significant agreement not attributable to chance for LS5 (understanding treatment situation/choices) (k = 0.57, P = .001), LS4 (providing rational reasons for treatment choice) (k = 0.39, P = .04), and also for personal judgments (k = 0.48, P = .009). Analysis of LS judgment agreement within physician indicated that physicians applied the LS as discrete standards. Within-physician and for the AD sample, personal competency judgments were associated significantly with judgments on LS5 (P = .001), LS4 (P = .004), and LS3 (P < .04). CONCLUSIONS: Experienced physicians demonstrated significant agreement assessing competency in AD patients when judgments were based upon specific legal standards. Personal competency judgments of physicians showed a substantially higher level of agreement than found in a previous study, where specific LS were not used. These results suggest that consistency of physician competency judgments can be enhanced if they are guided by knowledge of specific LS. Physicians' personal competency judgments were most closely associated with comprehension and reasoning LS, the most conservative and clinically appropriate standards for deciding competency.

Alzheimer Disease↗
PubMed1997

Childhood exposure to PM10: relation between personal, classroom, and outdoor concentrations.

OBJECTIVES: To investigate the validity of outdoor concentrations of particulate matter < 10 microns diameter (PM10) as a measure of exposure in time series studies, and to study the extent to which differences between personal and outdoor PM10 concentrations can be explained. METHODS: Four to eight repeated measurements of personal and outdoor PM10 concentrations were conducted for 45 children, aged 10-12 years, from four schools in Wageningen and Amsterdam, The Netherlands. Repeated PM10 measurements in the classrooms were conducted in three of the schools. Averaging time was 24 hours for the personal and outdoor measurements, and eight hours (daytime) and 24 hours for the classroom measurements. For each child separately, personal exposures were related to outdoor concentrations in a regression analysis. The distribution of the individual correlation and regression coefficients was investigated. Information about factors that might influence personal exposures was obtained by questionnaire. RESULTS: Median Pearson's correlations between personal and outdoor concentrations were 0.63 for children with parents who did not smoke and 0.59 for children with parents who smoked. For children with parents who did not smoke, excluding days with exposure to environmental tobacco smoke (ETS) improved the correlation to a median R of 0.73. The mean personal PM10 concentration was 105 micrograms/m3; on average 67 micrograms/m3 higher than the corresponding outdoor concentrations. The main part of this difference could be attributed to exposure to ETS, to high PM10 concentrations in the classrooms, and to (indoor) physical activity. CONCLUSIONS: The results show a reasonably high correlation between repeated personal and outdoor PM10 measurements within children, providing support for the use of fixed site measurements as a measure of exposure to PM10 in epidemiological time series studies. The large differences between personal and outdoor PM10 concentrations probably result from a child's proximity to particle generating sources and particles resuspended by personal activities.

Air Pollutants↗
PubMed2002

Personal exposure monitoring of particulate matter, nitrogen dioxide, and carbon monoxide, including susceptible groups.

AIMS: To investigate the relation between personal exposures to nitrogen dioxide, carbon monoxide, and PM(10), and exposures estimated from static concentrations of these pollutants measured within the same microenvironments, for healthy individuals and members of susceptible groups. METHODS: Eleven healthy adult subjects and 18 members of groups more susceptible to adverse health changes in response to a given level of exposure to nitrogen dioxide, carbon monoxide, and/or PM(10) than the general population (six schoolchildren, six elderly subjects, and six with pre-existing disease-two with chronic obstructive pulmonary disease (COPD), two with left ventricular failure (LVF), and two with severe asthma) were recruited. Daytime personal exposures were determined either directly or through shadowing. Relations between personal exposures and simultaneously measured microenvironment concentrations were examined. RESULTS: Correlations between personal exposures and microenvironment concentration were frequently weak for individual subjects because of the small range in measured concentrations. However, when all subjects were pooled, excellent relations between measured personal exposure and microenvironment concentration were found for both carbon monoxide and nitrogen dioxide, with slopes of close to one and near zero intercepts. For PM(10), a good correlation was also found with an intercept of personal exposure (personal cloud) of 16.7 (SD 10.4) micro g/m(3). Modelled and measured personal exposures were generally in reasonably good agreement, but modelling with generic mean microenvironment data was unable to represent the full range of measured concentrations. CONCLUSIONS: Microenvironment measurements of carbon monoxide and nitrogen dioxide can well represent the personal exposures of individuals within that microenvironment. The same is true for PM(10) with the addition of a personal cloud increment. Elderly subjects and those with pre-existing disease received generally lower PM(10) exposures than the healthy adult subjects and schoolchildren by virtue of their less active lifestyles.

Adult↗
PubMed2006

Tuberculosis among foreign-born persons in the United States: achieving tuberculosis elimination.

RATIONALE: In the United States, the number of annual reported cases of tuberculosis (TB) among U.S.-born persons declined by 62% from 1993 to 2004, but increased by 5% among foreign-born persons. Over half of all reported cases of TB in the United States occur among foreign-born persons, most of these due to activation of latent TB infection (LTBI). Current guidelines recommend targeting only foreign-born persons who entered the United States within the previous 5 yr for LTBI testing. OBJECTIVE: We sought to assess the epidemiologic basis for this guideline. METHODS: We calculated TB case rates among foreign-born persons, stratified by duration of United States residence and world region of origin. We determined the number of cases using 2004 U.S. TB surveillance data, and calculated case rates using population data from the 2004 American Community Survey. MEASUREMENTS AND MAIN RESULTS: In 2004, a total of 14,517 cases of TB were reported; 3,444 (24%) of these were among foreign-born persons who had entered the United States more than 5 yr previously. The rate of TB disease among foreign-born persons was 21.5/100,000, compared with 2.7/100,000 for U.S.-born persons, and varied by duration of residence and world region of origin. CONCLUSIONS: Almost one-quarter of all TB cases in the United States occur among foreign-born persons who have resided in the United States for longer than 5 yr; case rates for such persons from selected regions of origin remain substantially elevated. To eliminate TB, we must address the burden of LTBI in this high-risk group.

Communicable Disease Control↗
PubMed1995

Risk factors for adverse outcome in persons with pneumococcal pneumonia.

OBJECTIVE: To identify risk factors for death and respiratory failure in persons with penicillin-sensitive pneumococcal bacteremia and pneumonia from data available at initial clinical evaluation. DESIGN: Retrospective chart review of persons with pneumococcal bacteremia and pneumonia. SETTING: Tertiary care medical center (University of California Davis Medical Center, Sacramento). PATIENTS: One hundred two consecutive adults admitted to the hospital for treatment of pneumococcal pneumonia with bacteremia. RESULTS: Of 102 persons, 25 (25%; 95% confidence interval [CI], 17 to 34%) died and 17 (16%; 95% CI, 10 to 25%) survived mechanical ventilation for respiratory failure. In univariate analyses, persons with preexisting lung disease (relative risk [RR], 2.0; 95% CI, 1.3 to 3.1), initial body temperature < 38 degrees C (RR, 2.1; 95% CI, 1.3 to 3.6), or nosocomial infections (RR, 2.5; 95% CI, 1.8 to 3.6) or who were > or = 48 years old (RR, 2.7; 95% CI, 1.5 to 4.8) were at greater risk for adverse outcomes than persons without these risk factors. Of 25 persons without these risk factors, only one (4%; 95% CI, 0 to 20%) died, and the remaining 24 persons did not require intensive care. Using these risk factors in a multivariate logistic model, death or respiratory failure would have been predicted in 67% of persons and better outcome predicted in 83% of the persons. In multivariate analysis, nosocomial infection was the greatest risk factor (adjusted odds ratio, 17.3; 95% CI, 3.1 to 98). CONCLUSIONS: Risk factors identified at hospital admission can predict the outcome in persons with pneumococcal pneumonia and bacteremia. Identifying these factors may allow earlier use of intensive care or more aggressive treatment. Independent of age, nosocomially acquired infections were the greatest risk factor for death or respiratory failure.

Adult↗