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PubMed1997

Development of a test battery (NPM-X) for neuropsychological and neuromotor examination of children with developmental disabilities or mental retardation. A theoretical and clinical study.

Biological and behavioural diagnosis often do not provide information on functional competence. This is, however, of utmost importance in planning services as well as in research on treatment effects for children with developmental disorders. For school-aged children neuropsychological assessment has proved its value in this respect. For children of chronological age (CA) below 5-7 with specific developmental disabilities, and for children with severe mental retardation there has been a lack of applicable test batteries. This thesis presents a new test battery for neuropsychological and neuromotor examination, NPM-X, for these two groups of children. The first part of the thesis reviews available medical and psychological tests and assessment procedures with respect to applicability and relevance for neuropsychological assessment to children with mental retardation and mental age (MA) below 7. The second part describes the theoretical background and the content of the new test battery. The methodology for testing these children, who due to their age and/or their developmental disabilities often co-operate poorly, is described. Scoring categories, specifically developed to enable a detailed and differentiated description of the child, are presented. Because of the instability of the behavioural function in early age as well as in cases of severe disability, the scoring system records both the child's optimal functional capacity and inconsistencies in behaviour. For the purpose of planning treatment and training according to the child's resources as well as dysfunctions, two different functional profiles are provided. In the normative functional profile the child's functional level is compared to normal expectations for the child's CA, and in the ideographic functional profile the child's function in each area is compared to the child's average functional level. In the third part of the thesis the reliability results are presented and discussed. A pair of trained M.D.s, or psychology or special education Ph.D.s examined 110 children in a blind design. The study showed satisfactory interrater and test-retest reliability. In the fourth part current validation theory is reviewed before content and construct validity for the test battery is discussed. A concurrent criterion validation study is presented as well. Assessments available in the psychological and psychiatric records (PPR) of 35 children with CA below 7 were compared to test results obtained with NPM-X. The comparison showed high agreement in areas of function assessed both by PPR and NPM-X. In addition, NPM-X provided more information about the child's functional capacity, of relevance for the diagnostic appraisal as well as for the treatment of the child. It is concluded that a reliable and valid test battery for neuropsychological and neuromotor developmental assessment has showed its applicability and clinical utility for children with specific developmental disabilities and CA < 7 and for children with general developmental disabilities up to CA 12-13 but with MA < 7.

Adolescent↗
PubMed2003

Providing affordable family housing and reducing residential segregation by income. A systematic review.

The inadequate supply of affordable housing for low-income families and the increasing spatial segregation of some households by income, race, ethnicity, or social class into unsafe neighborhoods are among the most prevalent community health concerns related to family housing. When affordable housing is not available to low-income households, family resources needed for food, medical or dental care, and other necessities are diverted to housing costs. Two housing programs intended to provide affordable housing and, concurrently, reduce the residential segregation of low-income families into unsafe neighborhoods of concentrated poverty, are reviewed: the creation of mixed-income housing developments and the Department of Housing and Urban Development (HUD) Section 8 Rental Voucher Program. The effectiveness of mixed-income housing developments could not be ascertained by this systematic review because of a lack of comparative research. Scientific evidence was sufficient to conclude that rental voucher programs improve household safety as measured by reduced exposure to crimes against person and property and decreased neighborhood social disorder. Effectiveness of rental voucher programs on youth health risk behaviors, mental health status, and physical health status could not be determined because too few studies of adequate design and execution reported these outcomes.

Family↗
PubMed2001

Efficacy of a clinical medication review on the number of potentially inappropriate prescriptions prescribed for community-dwelling elderly people.

BACKGROUND: The administration of many drugs concurrently to elderly patients is a well-known problem in geriatrics and involves numerous risks. One way to reduce polypharmacy is to provide information to physicians in order to modify their prescribing practices. The main objective of this study was to evaluate the impact of an intervention program that targeted physicians with the aim of reducing the number of potentially inappropriate prescriptions (PIPs) given to elderly patients. METHODS: A randomized controlled trial was carried out among community-dwelling elderly people in Sherbrooke, Que. The participants were 266 patients over 75 years of age (experimental group: n = 136, control group: n = 130). A team comprising 2 physicians, a pharmacist and a nurse reviewed the list of drugs and the diagnoses of a subgroup of the experimental group in a case conference. Suggestions were formulated and mailed to the patients' physicians together with relevant scientific documentation justifying the recommendations. The main outcome measure was the number of PIPs. RESULTS: The mean number of PIPs per patient declined by 0.24 in the experimental group (n = 127) and by 0.15 in the control group (n = 116). The decline in PIPs was even larger in the experimental group that had case conferences (n = 80), in which the mean number of PIPs per patient declined by 0.31. However, this difference between the experimental group and the control group was not statistically significant in the intent-to-treat analysis. The number of drugs prescribed was not modified by the intervention, nor were the results of the global assessment of the patients' drug profiles. INTERPRETATION: This study suggests that the intervention program had no effect on the prescribing of PIPs.

Activities of Daily Living↗
PubMed2001

Sweet's syndrome in association with Crohn's disease: report of a case and review of the literature.

A 41-year-old woman developed a skin rash as part of Sweet's syndrome concurrent with the first episode of Crohn's disease of the colon. Sweet's syndrome, acute febrile neutrophilic dermatosis, may be associated with inflammatory, infectious, or neoplastic diseases. Its association with Crohn's disease is very rare, and when reported it has been mainly associated with Crohn's colitis. This association has been described in various stages of the disease. Sweet's syndrome may be considered one of the extraintestinal manifestations of Crohn's disease. Early diagnosis of this dermatosis may be important because of the prompt response to treatment with corticosteroids. The value of metronidazole should be considered because this medication may enhance response to treatment.

Adult↗
PubMedDate not supplied

Concurrent focal hepatic and splenic lesions: a pictorial guide to differential diagnosis.

Although medical literature and differential diagnoses discussions tend to be organ specific, systemic diseases more commonly manifest with multi-organ involvement. Detection of dual organ involvement combined with clinical history narrows the differential to provide a more specific diagnosis. Two organs closely linked are the liver and the spleen. Many processes affect both of these organs through their common denominator, the reticuloendothelial system (RES). This pictorial essay reviews the wide spectrum of benign and malignant pathologies to be considered when computed tomography (CT) demonstrates concurrent focal disease in the liver and spleen.

Adult↗
PubMed2004

Coronary artery anomalies. Part I: Recent insights from molecular embryology.

Congenital anomalies of the coronary arteries occur in 0.2-1.2% of the general population and may cause substantial cardiovascular morbidity and mortality. We review some of the advances that have been made both, in the understanding of the embryonic development of the coronary arteries (part I) and in the clinical diagnosis and management of their anomalies (part II). In this first part of our review we elucidate basic mechanisms of coronary vasculogenesis, angiogenesis and embryonic arteriogenesis. Moreover, we review the role of cellular progenitors such as epicardium-derived cells, cardiac neural crest cells and cells of the peripheral conduction system. Then we discuss the role of growths factors (such as FGV, HIF 1, PDGF B, TGFbeta1, VEGF, and VEGFR-2) and genes (such as FOG-2, VCAM-1, Bves, and RALDH2) at different states of coronary development. and we discuss the role of the cardiac neural crest in the concurrence of coronary anomalies with aortic root malformations. This part of the article is designed to review major determinants of coronary vascular development to provide a better understanding of the multiplicity of options and mechanisms that may give rise to coronary anomaly. To this end, we highlight results from experiments that provide insight in mechanisms of coronary malformation.

Animals↗
PubMed1992

Diabetic ketoacidosis and hyperosmolar coma.

DKA-hyperosmolar coma is a readily diagnosed and easily treated, potentially catastrophic emergency that regularly occurs in both Type I and Type II diabetics. This review emphasized that diabetic ketoacidosis and hyperosmolar coma can, and very frequently do, occur concurrently, but it is the hyperosmolar state rather than the DKA that is the primary cause of coma and death in this condition. One must therefore vigorously treat the hyperosmolarity and resulting dehydration, especially when total calculated osmolarity exceeds 230 to 240 mOsm/L. The major aim of treatment is to rapidly replace the major water loss that is responsible for this clinical condition and to stimulate glucose metabolism with insulin. The diagnosis of this dangerous condition is relatively simple. The therapy, in most regards, is equally apparent. There are good data demonstrating that the prompt recognition of DKA-hyperosmolar coma and the simple institution of rapid rehydration have continued to reduce the mortality and complications of this potentially disastrous complication of diabetes mellitus.

Diabetes Complications↗
PubMed1997

Factors influencing the outcome of group psychotherapy for bulimia nervosa.

OBJECTIVE: Group psychotherapy is a widely used form of treatment for bulimia nervosa, and many open and controlled studies have demonstrated that it is relatively effective. However, it is not clear what factors enhance or reduce that effectiveness. This review considers the potential role of a number of such factors. METHOD: The literature on the effectiveness of group psychotherapy was selected on the basis of its publication inclusion in peer-reviewed journals. Unpublished material was not included. Factors considered included theoretical orientation, therapy dose, concurrent treatment, client characteristics, and service characteristics. RESULTS: The research to date shows no obvious advantage attached to any single therapeutic orientation or to the gender of therapists. However, other aspects of group psychotherapy do seem to influence outcome. Better outcomes are associated with longer, more intensively scheduled groups and with the addition of other treatment components (e.g., individual work). There is also evidence that relatively large groups are a viable option. These conclusions are reasonably congruent with clients' own expressed preferences regarding therapy. DISCUSSION: It is suggested that future research should focus on matching the characteristics of individual bulimics to the nature of the group psychotherapy, in order to increase engagement and effectiveness while reducing drop-out rates.

Bulimia↗
PubMed2005

Migraine during pregnancy: options for therapy.

Migraine is common during pregnancy, but fortunately this combination of conditions obviously exists for only a finite period. The greatest frequency of migraine attacks occurs during the first trimester. Accurate diagnosis is a sine qua non in this setting as in any headache patient. It is in the first trimester that the fetus is at greatest risk from abortifacient and teratogenic drugs, and when very early pregnancy may be undiagnosed. Ergot alkaloids (including methysergide) should be avoided during pregnancy because of their teratogenicity, and most other drug classes should be used only when unavoidable. The use of prophylactic agents during pregnancy should be the exception, not the rule, and preferably only during the second and third trimesters; propranolol is probably safest in this situation. De novo headache during pregnancy usually requires expert review of the patient. Treatment tactics for uncomplicated migraine in pregnancy depend on the concurrent clinical situation. Paracetamol (acetaminophen) is the mainstay for the patient whose typical attacks continue into the first trimester. If paracetamol is insufficient, then partial agonist opioids may be used if typical migraine attacks persist in the second and third trimesters (which is uncommon). 'Chronic migraine' in pregnancy, i.e. >or=15 headache days per month, is rare, and is the greatest therapeutic challenge. Co-morbidities such as depression or epilepsy require specialised approaches. The complexities associated with these tactics are discussed in this article, and it is emphasised that none has the specific approval of regulatory authorities. Heightened pharmacovigilance will better inform the future pregnant migraineur. However, this type of information is less likely to be available for novel classes of neuropharmacological agents than for existing ones.

Analgesics↗
PubMed2004

Lymphedema following breast cancer treatment, including sentinel lymph node biopsy.

To compare the occurrence, signs, and symptoms of lymphedema (LE) the arms of women after axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), combined SLNB and ALND (Both), or neither as part of breast cancer diagnosis and treatment, a concurrent descriptive-comparative cross-sectional four-group design with retrospective chart review was carried out. In a convenience sample of 102 women treated for breast cancer and receiving follow-up care at a midwestern United States cancer center, sequential circumferential measurements at five selected anatomical sites along both arms and hands were used to determine the presence of LE (> or = 2 cm differences between sites). Participants self-reported LE-related signs and symptoms by interview and completion of the Lymphedema and Breast Cancer Questionnaire (LBCQ). Retrospective chart review was carried out to verify lymph node-related diagnostic and treatment procedures. Based on node group, LE occurred as follows: 43.3% (29 of 67) of women who underwent ALND alone; 22.2% (2 of 9) of those who underwent SLNB alone; 25.0% (3 of 12) of those with combined SLNB and ALND; and 22.2% (2 of 9) with neither SLNB nor ALND. LE-related symptoms were reported by women who underwent ALND alone, SLND alone, combined SLNB and ALND, and neither. Among the node groups, three symptoms were more common: larger arm size, firmness/tightness in past year, and numbness in past year. We conclude that circumferential measurements of the upper arm and forearm may be critical for distinguishing LE from no LE. Overall, the proportion of women who experienced LE-related signs and symptoms was higher among women who underwent ALND versus SLNB. However, numbness and tenderness frequently were reported by those undergoing ALND, SLNB or both; and by women without LE. It is possible that some frequently occurring symptoms, such as numbness and tenderness, may be related to breast cancer surgery and not LE. Findings from this study can assist health professionals in educating women with breast cancer about LE risk factors, as well as early detection and management of LE by using the LBCQ and sequential circumferential arm measurements to evaluate limb changes subjectively and objectively concurrent with each breast cancer survivor's follow-up care.

Adult↗
PubMed1996

Human polyoma virus infection of renal allografts: histopathologic diagnosis, clinical significance, and literature review.

Human polyoma virus infection was diagnosed by a needle biopsy of the allograft in two kidney transplant recipients. Viral infection was initially suggested by the occurrence of markedly enlarged tubular epithelial cells with nuclear atypia and chromatin basophilia. Confirmatory evidence was obtained by immunohistochemistry in both cases, and electron microscopy in one instance. Case 1 presented as a refractory interstitial nephritis and underwent allograft nephrectomy. Case 2 showed viral infection concurrent with acute cellular rejection. The rejection initially responded to treatment, but recurred twice on subsequent followup. A review of the literature indicates that asymptomatic infection, ureteric stricture and hemorrhagic cystitis are other possible manifestations of polyoma virus in the human urogenital tract.

Adolescent↗
PubMed1995

Selective serotonin reuptake inhibitors and tricyclic antidepressants in combination. Interactions and therapeutic uses.

BACKGROUND: The selective serotonin reuptake inhibitors (SSRIs) are now widely used in the treatment of depressive illness. Interest has grown in the use of SSRIs as alternatives to tricyclic antidepressants (TCAs) and in the therapeutic use of combinations of SSRIs and TCAs in refractory depression. METHOD: MEDLINE and PSYCLit literature searches were conducted. Reference sections from papers retrieved were scrutinised for other relevant reports. RESULTS: Of 41 relevant articles identified, 35 were selected for review. CONCLUSIONS: Fluoxetine, fluvoxamine, paroxetine and sertraline may substantially increase TCA plasma levels when given concurrently. Such interactions may give rise to adverse effects. The effect of sertraline may be less profound than that of fluoxetine, fluvoxamine and paroxetine. Limited data suggest that citalopram may not affect TCA serum levels. There is scant literature evidence to support the use of SSRIs in combination with TCAs as a treatment for refractory depression.

Antidepressive Agents, Tricyclic↗
PubMed2002

Developing a sustainable energy strategy for a water utility. Part II: A review of potential technologies and approaches.

Environmental legislation is increasing the amounts of bought-in electricity required for sewage treatment, and generating larger volumes of sewage sludge to be treated and disposed of. Concurrently, concerns over global warming and food safety from sewage sludge recycling on agricultural land is augmenting the costs of conventional sewage and sludge treatment technologies and practices. This paper reviews some emerging technologies and practices that may assist in mitigating these problems in the future. In addition, a number of potential renewable energy technologies available to water companies are reviewed. Results suggest that through the take-up of new technologies, current and future water quality standards could be delivered in a more sustainable way. However, this series of papers also highlights that institutional and political conflicts may have inadvertently failed to recognise the wider effects of improving water quality and lessened the financial support necessary for their widespread take-up. It is also suggested that through the use of a Strategic Environmental Assessment (SEA) approach, stakeholders could gain a better understanding of the broader environmental effects of achieving certain water quality standards and develop policy and long-term investment strategies accordingly. However, to fulfill the information requirements of an SEA, an appropriate appraisal tool that considers many of these factors in unison is required, and a possible technique is suggested.

Conservation of Natural Resources↗
PubMed1983

Early return to work after repair of a unilateral inguinal hernia.

Ninety-seven Royal Naval and Royal Marine officers and ratings undergoing repair of a unilateral inguinal hernia were randomized postoperatively into two groups: A, those who returned to full working duties 21 days after operation; B, those who returned to light duties 21 days after operation and to full duties at 3 months. Patients were reviewed at 3 and 12 months. One patient was withdrawn because of the development of late sepsis. Two patients in group B developed a recurrence of hernia within 1 year. No patient who returned to full duties at 21 days was unable to do any duty assigned to him. In a concurrent trial 119 male civilian patients were treated in the same hospital under identical conditions. All patients were reviewed 21 days after operation and were randomized into two groups: C, those advised to return to work immediately; D, those given no advice. Patients in group C returned to work in a mean of 38 days (range 14-96 days), whereas those in group D returned in a mean of 71 days (range 14-280 days). There was no recurrence of hernia in either group within the review period. It is concluded that there is no contraindication to resuming physical work 3 weeks after the uncomplicated repair of a unilateral inguinal hernia, and that active encouragement shortens the interval before return to work.

Adolescent↗
PubMed1998

Radiation and chemotherapy in the management of malignant esophageal strictures.

The management of malignant and esophageal strictures with radiation and chemotherapy is reviewed. There is no evidence to support the use of adjuvant radiation. Studies demonstrate that concurrent chemotherapy and radiation are superior to radiation alone. The trials of preoperative combined chemotherapy and radiation are discussed, and it is suggested that further studies are needed before such treatment could be accepted as standard therapy. The roles of radiation and chemotherapy in palliative management are briefly discussed, and some potential areas for further study are proposed.

Antineoplastic Agents↗
PubMed1997

Retrospective study of selegiline-antidepressant drug interactions and a review of the literature.

Selegiline is a selective monoamine oxidase inhibitor used in the treatment of Parkinson's disease. It is estimated that approximately one-half of Parkinsonian patients will develop depression requiring antidepressant drug treatment. Recently, selegiline's package insert was revised to reflect the potential risk of adverse effects when it is used in combination with selective serotonin reuptake inhibitors and tricyclic antidepressants. The objective of our study is to assess the safety of combining selegiline with antidepressants. A retrospective chart review was performed on all 28 patients with Parkinson's disease receiving selegiline and antidepressants concurrently to identify possible drug interactions. Compliance was assessed according to prescription refill records. Suspected adverse reactions with combination therapy were documented. There was a total of 40 selegiline-antidepressant drug combinations involving tricyclic antidepressants (n = 25), selective serotonin reuptake inhibitors (n = 7), trazodone (n = 5), and bupropion (n = 3). One patient receiving fluoxetine developed a reaction consistent with the serotonin syndrome; however, it was never documented as such. No other selegiline drug interactions were found. Adverse effects noted were typical of antidepressant monotherapy. Although no selegiline drug interactions were documented in our study, the concurrent administration of selegiline and selective serotonin reuptake inhibitors should be avoided because of literature-reported interactions. We believe that bupropion, tricyclic antidepressants, and trazodone are reasonable choices in combination with selegiline, although tricyclic antidepressants and trazodone may be reserved as second-line treatments.

Antidepressive Agents, Second-Generation↗
PubMedDate not supplied

Frequency of simvastatin prescriptions with potentially interacting medications in a Veterans Affairs health care system.

OBJECTIVE: The primary objective of this review is to quantify the proportion of patients on simvastatin, an HMG-CoA reductase inhibitor (commonly known as statin), who received concurrent prescriptions for potentially interacting chronicuse medications. The secondary objective is to determine the frequency with which simvastatin was prescribed above its recommended dose when administered concomitantly with known interacting medications. METHODS: A retrospective review of computerized outpatient pharmacy records from a Veterans Affairs Medical Center and its associated ambulatory clinics was performed in September 2002. RESULTS: A total of 12,240 patients had an active prescription for a statin. The majority of patients (95%, N = 11,677) were on simvastatin therapy, and 1,231 (10.5%) of the patients on simvastatin were prescribed at least 1 potentially interacting medication. More than one half (57.8%) of simvastatin doses were above the maximum recommended daily dose when prescribed with potentially interacting medications. CONCLUSION: This analysis supports the need for vigilance in reviewing the dose of simvastatin in patients receiving interacting medications. Health care systems should consider strategies to educate health care professionals on prevention of drug interactions and adverse patient outcomes.

Aged↗
PubMed2000

Gauging the effects of mass media policies: what do we need to know?

This article explores the components of an effective mass media policy and the role of mass media campaigns as part of a comprehensive set of tobacco control strategies. First, the main findings of the empirical literature are briefly reviewed. Then a framework for understanding mass media policies is developed showing the influence of concurrent tobacco control policies and the interrelationship between the two. A model will be presented that draws on concepts and research from the advertising and marketing literature, as well as from public health studies. A discussion of limitations of the extant literature and issues that warrant further examination will conclude.

Advertising↗