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Consequences of congenital hearing loss - a longterm view.

Responsibility for detection of hearing loss at the earliest possible age rests on the shoulders of the medical profession. Early detection and presentation of language through all available sensory channels, most notably the visual, are essential since deaf children of hearing parents, the vast majority of the deaf, characteristically remain grossly deficient linguistically despite years of special schooling. The deaf children of deaf parents, who are not as deprived linguistically since they learn a manual language at the normal age of language acquisition, tend to be less severely handicapped than the deaf children of hearing parents. Deafness is a hidden handicap in infancy although lack of vestibular function may delay motor milestones like sitting and walking but does not constitute a serious problem after they are achieved. The average 18 year old deaf student achieves a reading level comparable to that of a hearing fourth grader and the mathematical skills of a sixth grader. He is also deficient in science, social studies, and general information despite his average scores on nonverbal intelligence tests. Although many deaf students drop out of school before graduation and few go on to higher education, congenitally deaf adults are usually self-supporting and independent. Eighty per cent of the deaf marry hearing impaired persons. The deaf are greatly assisted by the cohesive deaf community existing in every sizable city which provides a social, recreational, and economic framework to their lives. As a result, delinquency and psychiatric illness are not higher among the deaf than the hearing, despite the difficulties they have dealing with the complexities of the hearing society.

Adolescent↗

Who needs change? Moving from research to clinical studies.

Classification in psychiatry serves as a basis for communication within science, as a basis of information retrieval, as a descriptive system, as a source for the construction of theories, and finally as a basis for making predictions. Not only has research diagnostic criteria had significant importance to research, but they can now serve the clinician equally well as exemplified by DSM III.

Bipolar Disorder↗

The Jeremiah Metzger Lecture. Humanities in medicine: treatment of a deficiency disorder.

Al Jonson pointed out that Sir William Osler provided one of the best rationales for Humanities in Medicine (21, 65). In 1919, in one of Sir William's last lectures given just a few months prior to his death, a lecture to the British Classical Society, he discussed how the sciences and the humanities can inform each other. He compared the humanities to thyroid hormone-thyroxine had just been discovered in 1914-"a hormone...," Sir William said, "...which lubricates the wheels of life... Deprive man of the lubricants ... and ... he sinks into dementia..." And so to the Classical Society, Sir William said, "You secrete materials which do for society at large what the thyroid gland does for the individual. The humanities are the hormones..." And Al Jonsen suggested that we in Medicine reaffirm Sir William's metaphor that the humanities are the hormones which will do for medicine what they do for society at large.

Cartoons as Topic↗

Multivariate analysis of DNA ploidy, p53, c-erbB-2 proteins, EGFR, and steroid hormone receptors for prediction of poor short term prognosis in breast cancer.

BACKGROUND: Several molecular-genetic alterations in breast cancer, including aneuploidy, aberrant expression of p53, c-erbB-2 and EGFR, have been associated with poor prognosis in breast cancer patients particularly those who are lymph node negative. To determine the importance of molecular-genetic factors relative to more traditional surgical-pathologic prognostic factors, multivariate analysis was performed on lymph node positive breast cancer cases. METHODS: One hundred fresh samples of primary breast carcinoma were studied with flow cytometry for DNA ploidy. On the same specimens steroid hormone receptors (ER and PR) were measured in the cytosol fraction using Abbott ELIZA assays, c-erbB-2 and EGFR were determined in the membrane fraction and mutant p53 protein in the nuclear fraction by Oncogene Science ELISA procedures. In addition, information regarding surgical-pathologic features of the tumor was obtained. Multivariate analysis using Cox's proportional hazards model was done to identify variables predictive of poor prognosis. RESULTS: Using univariate analysis, tumor size, lymph node number, p53, c-erbB-2 were predictive of poor short term prognosis. By multivariate analysis, only c-erbB-2 (P = 0.001) and p53 (P = 0.05) were significant. Subsgroup analysis by nodal status yields a significant association of c-erbB-2 (P = 0.001) and p53 (P = 0.04) with lymph node positive breast cancer. CONCLUSIONS: Among molecular-genetic prognostic factors, c-erbB-2 was the most strongly predictive of poor short term prognosis followed by p53 in lymph node positive breast cancer.

Adult↗

Multivariate analysis of DNA ploidy, p53, c-erbB-2 proteins, EGFR, and steroid hormone receptors for short-term prognosis in breast cancer.

BACKGROUND: Several molecular-genetic alterations in breast cancer, including aneuploidy, aberrant expression of p53, c-erbB-2, and EGFR have been associated with poor prognosis in breast cancer particularly in lymph node negative patients. To determine the importance of molecular-genetic factors relative to more traditional surgical-pathologic prognostic factors, a multivariate analysis was performed particularly in lymph node positive breast cancer cases. METHODS: One hundred fresh samples of primary breast carcinoma have been studied with flow cytometry for DNA ploidy. On the same specimens steroid hormone receptors (ER and PR) were measured in cytosol fraction using Abbott ELIZA assays, c-erbB-2 and EGFR were determined in the tissue homogenate and mutant p53 protein in the nuclear fraction by Oncogene Science ELISA procedures. In addition, information regarding surgical-pathologic features of the tumor was obtained. Multivariate analysis using Cox's proportional hazards model was done to identify variables predictive of poor prognosis. RESULTS: With univariate analysis, tumor size, lymphnode number, p53, c-erbB-2 were predictive of poor short term prognosis. In the multivariate analysis, only c-erbB-2 (P = 0.001) and p53 (P = 0.05) were significant. Subgroup analysis by nodal status yielded significant association of c-erbB-2 (P = 0.001) and p53 (P = 0.04) with lymph node positive breast cancer. CONCLUSIONS: Among molecular-genetic prognostic factors, c-erbB-2 was the most strongly predictive of poor short term prognosis followed by p53 in lymph node positive breast cancer.

Adult↗

Preschool vision screening.

OBJECTIVES: To undertake a systematic review of the effectiveness of preschool vision screening. To provide evidence on which decisions about the future provision of this service can be made. To indicate areas for further research. STUDY SELECTION: The Centre for Reviews and Dissemination guidelines for systematic reviews were used. The research questions were formulated using the Wilson and Jungner criteria for evaluating screening programmes. They concerned prevalence, natural history, disability, treatment and screening in relation to three target conditions: amblyopia, refractive errors and squints which are not cosmetically obvious. Studies were considered for inclusion according to pre-determined criteria for the age group studied, the outcomes measured and the study design. The following types of study design were considered: cross-sectional studies of prevalence, cohort studies of natural history, any type of study (e.g., cross-sectional surveys, case-series, qualitative studies) of disability attributable to a target condition, controlled trials, observational studies and audits of screening programmes, and prospective controlled trials of treatment. DATA SOURCES: The following electronic databases were searched: Biological Abstracts, CINAHL, Embase, ERIC, IAC Health Periodicals, IAPV, Medline, Psychlit, Science Citation Index, System for Information on Grey Literature in Europe, DHSS-Data, Faculty of Public Health Medicine Database of Dissertations, Index of Scientific and Technical Proceedings, Dissertation Abstracts, Index of Theses, NHS Research Register, Public Health Information Sharing Database. A limited amount of handsearching was undertaken. Reference lists were scanned to identify other relevant studies, and requests for unpublished data were made to people working in the field. DATA EXTRACTION: Data was extracted by the first author and then checked by the second. DATA SYNTHESIS: Quantitative analysis was undertaken where possible. Qualitative analysis was performed where studies were too heterogeneous for the data to be combined, or for research questions that were not suitable for quantitative synthesis. RESEARCH FINDINGS: The electronic search yielded over 5000 references, and over 500 abstracts were downloaded from the databases for further scrutiny. A total of 85 studies were included in the main analysis. PREVALENCE: No studies were found with the primary aim of establishing the prevalence of visual defects in preschool children. Data from studies of screening programmes report a range of yields for all the target conditions combined of 2.4-6.1%. NATURAL HISTORY: No studies designed with the intention of documenting the natural history of the target conditions in children aged 3 or 4 years were found. Other studies that provide some natural history data suggest that mild degrees of amblyopia may resolve spontaneously. In the absence of information about natural history it is impossible to estimate the effect of treatment from studies without a control group that was not treated. DISABILITY: A total of 21 studies exploring disability in relation to the target conditions were included. The literature provides a reasonable basis for generating plausible hypotheses about the ways in which the target conditions might disable people, but is insufficient to draw any firm conclusions about their impact on quality of life. The research to date is not sufficient to determine appropriate outcomes for controlled trials of treatment. TREATMENT: Five randomised controlled trials of treatment and six prospective controlleld trials without randomisation were found. No studies compared treatment with no treatment. Most of the studies were methodologically flawed.(ABSTRACT TRUNCATED)

Child, Preschool↗

Working IT out in e-Science: experiences of requirements capture in a HealthGrid project.

This paper reports on our experiences of being involved in requirements capture for a HealthGrid project. Large scale, collaborative projects with multiple partners tend to experience numerous problems in the requirements capture phase (and often beyond) and HealthGrid projects are no exception. Projects with highly innovative objectives often have additional sets of problematics, however. In carving out new visions of, for example, clinical research and healthcare service delivery, HealthGrid projects have to reckon with--and work within--existing healthcare policy, legislative frameworks, professional cultures and organisational politics as well as the more common integration problem of dealing with legacy systems. Such factors are not conducive to the achievement in healthcare of the e-Science vision of seamless integration of information and collaborative working across administrative, professional and organisational boundaries. In this paper, we document some of the challenges we encountered in investigating the requirements for eDiaMoND, a flagship pilot UK e-Science project. We discuss what we might learn from these challenges, especially approaches to requirements capture that are appropriate for projects with innovative aims and are also sensitive to representing and addressing what may be complex professional and organisational interests.

Computer Communication Networks↗

[Informatics in mental sciences: clinical data management and "expert systems"].

The role of information systems and particularly that of expert systems in medicine is analysed in brief. It is pointed out that, unlike other branches of medicine, in mental sciences the role of expert systems has so far been more limited because of certain intrinsic problems of programming on the one hand, and the scientific models of the psychiatrist on the other. An improvement in information technology and programming languages and better empirical classification of mental disturbances could provide useful bases for the realisation of computerised consultancy systems in mental sciences.

Algorithms↗

Information-theoretic latent distribution modeling: distinguishing discrete and continuous latent variable models.

Distinguishing between discrete and continuous latent variable distributions has become increasingly important in numerous domains of behavioral science. Here, the authors explore an information-theoretic approach to latent distribution modeling, in which the ability of latent distribution models to represent statistical information in observed data is emphasized. The authors conclude that loss of statistical information with a decrease in the number of latent values provides an attractive basis for comparing discrete and continuous latent variable models. Theoretical considerations as well as the results of 2 Monte Carlo simulations indicate that information theory provides a sound basis for modeling latent distributions and distinguishing between discrete and continuous latent variable models in particular.

Behavioral Sciences↗

Revelations from a meta database system on environmental health problems.

Harmful effects of environmental pollution to the health status of population is well-known to ecologists and experts on health sciences. However, prevention and protection against such direct environmental hazards to save, or, in a worse case, re-establish the ecological balance are anything but successful. It is true, even if modern monitoring and measuring technology, adequate information systems, and related data bases are available. Precision of measurements and surveys, assessment and evaluation of the relationship between component elements of negative environmental effects on one the one hand, and general health conditions of the population on the other, could be increased by applying methods of informatics i.e., if we carry out a preliminary and professional analysis of the already existing information property. A useful tool for such activities could be the creation and maintenance of an integrated meta-type data base. It is a set sorted by a causal relations group of information that is collected from several databases of different origin, as pre-defined by the task. Our task was to systematize valuable information collected from different fields of science and research (competencies), to compare them with international standard databases, and thus, to discover new inter-relations, create new values. As an input, one could envisage a network of satellite data bases evaluating relevant results of scientists and research institutions. The main database itself could contain standard national and international information on environmental health care. The output of the system could be relational analysis produced by the meta-system on the basis of results provided by the satellite systems. Thus, frequently, even without carrying out a particular survey, one could already suspect that certain environmental health hazards exist, or plan and implement certain measurements and surveys in a more precisely targeted way. An unlimited number of local satellite workstation modules of experts and research institutions may be linked to the meta database. Information property created as a result of special analysis and annotation might create a knowledge basis for free access by participants. Thus not only would their scientific backgrounds be strengthened, but services would also be provided by the meta database which could be diversified continuously. The satellite systems, the sorting and retrieval functions of the database, and its graphical services would provide a loose but flexible micro-computer system that could be linked together by autonomous or networked workstations. Our system is written on FoxPro and uses FoxGraph. At a medium level of capacity, it requires 1 MB free RAM and 14-16 MB fixed memory. The system already shows a certain specialization: the 'PubHealth' system from general issues of environmental health care leans towards problems related to sub-toxic long term effects and correlations to health insurance risk assessment (cost-benefit, risk-benefit analysis). However, new issues are also emerging when experts wish foremost to utilize the philosophy of the system (e.g., epidemiological mental-hygienic surveys related to life style and social status).

Computer Communication Networks↗

Inositol for respiratory distress syndrome in preterm infants.

BACKGROUND: Inositol is an essential nutrient required by human cells in culture for growth and survival. Inositol promotes maturation of several components of surfactant and may play a critical role in fetal and early neonatal life. OBJECTIVES: To assess the effectiveness/safety of supplementary inositol in preterm infants with RDS in reducing adverse neonatal outcomes. SEARCH STRATEGY: Medline, Embase, and Reference Update Databases were searched in August 1997 using key words: inositol and infant-newborn and random allocation or controlled trial or randomized trial (RCT). The reference lists of identified RCTs, personal files and Science Citation Index were searched. Unpublished additional information was obtained from the authors of one RCT published in abstract form. SELECTION CRITERIA: All randomized controlled trials of inositol supplementation to preterm infants with a control group that received a placebo or no intervention were included. Outcomes of interest were bronchopulmonary dysplasia (BPD), death, BPD or death, retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and sepsis. DATA COLLECTION AND ANALYSIS: Data on neonatal outcomes were abstracted independently by the two researchers and any discrepancy was resolved through consensus. Revman was used for analysis of the data. MAIN RESULTS: Four reports of three RCTs were identified. One report was a duplicate publication. The outcome of death or bronchopulmonary dysplasia was reported in two trials, and was found to be significantly reduced (RR 0.56, 95% CI 0.42, 0.77; RD -0.215, 95% CI -0.323, -0.107). The outcome of death was reported in two trials and was found to be significantly reduced (RR 0.48, 95% CI 0.28, 0.80; RD -0.131, 95% CI -0.218, -0.043). Retinopathy of prematurity, stage 4 or needing therapy, was reported in two trials, and was found to be significantly reduced (RR 0.09, 95% CI 0.01, 0.67; RD -0.078, 95% CI -0.128, -0.027). Intraventricular hemorrhage, grade III-IV, was significantly decreased (RR 0.55, 95% CI 0.32, 0.95; RD -0.090, 95% CI -0.170, -0.010). Neither sepsis nor necrotizing enterocolitis outcomes were increased. When a secondary analysis was done excluding a study published in abstract form, the results differed only in that there was a significant reduction in retinopathy of prematurity, any stage (RR 0.53, 95% CI 0.29, 0.97; RD -0.082, 95% CI -0.159,-0.005). REVIEWER'S CONCLUSIONS: Inositol supplementation results in statistically significant and clinically important reductions in important short-term adverse neonatal outcomes. A multi-center RCT of appropriate size is justified to confirm these findings.

Dietary Supplements↗

Evolving technologies: a planner's challenge in the information age.

Although strategic planning is now a familiar process for most hospitals, the probable impact of new technology on the hospital and society is frequently overlooked. This technology is transforming medicine into a quantitative science and is providing a multitude of new information. Effective management of this information is vital to continued quality medical care. This article addresses the impact of new technologies not as an individual event but as an influence on the health care community and society as a whole.

Diffusion of Innovation↗

[Intensification and effectiveness of scientific research in hygiene (several problems of information supply)].

The nature of the concept "intensification" and the notions effect and effectiveness, associated with it are discussed. The nature of the separate kinds effect, obtained in hygienic science are determined - primary (health) and secondary (derivative). Effectiveness is determined on that base - as juxtaposition of the kinds of effects obtained with the resources spent in the field of hygienic science. Studies were carried out on the increased intensity of utilization of information resources as factor for the improvement of effectiveness in hygienic science. The place and role of information - retrieval systems are determined. Numerous concrete information systems are discussed as well as some of the factors in the evaluation of their effectiveness.

Bulgaria↗

Information management and informatics: need for a modern pathology service.

Requirements for information technology in pathology now extend well beyond the provision of purely analytical data. With the aim of achieving seamless integration of laboratory data into the total clinical pathway, "informatics"--the art and science of turning data into useful information--is becoming increasingly important in laboratory medicine. Informatics is a powerful tool in pathology--whether in implementing processes for pathology modernization, introducing new diagnostic modalities (e.g. proteomics, genomics), providing timely and evidence-based disease management, or enabling best use of limited and often costly resources. Providing appropriate information to empowered and interested patients--which requires critical assessment of the ever-increasing volume of information available--can also benefit greatly from appropriate use of informatics. General trends in medical informatics are reflected in current priorities for laboratory medicine, including the need for unified electronic records, computerized order entry, data security and recovery, and audit. The increasing demands placed on pathology information systems in the context of wider developmental change in healthcare delivery are explored in this paper.

Data Collection↗

Teaching of space life sciences.

Space life sciences is not really a new life sciences discipline such as immunology was some decades ago and it may never be so. Rather it is a field that will provide each existing life sciences discipline with new and more information gathered from space research. In fact, the danger is that space research will be confined in a separate discipline, and thus it will be cut off from classical ground research. Conversely, scientists should increasingly consider spaceflight as a tool and should integrate the findings of space research into their traditional disciplines. A brief survey of topics and main findings in the various subdisciplines of space life sciences is provided. This is followed by a discussion of typical problems encountered such as access to space, controls, ground-based simulations, medical care in space, extravehicular activity, and environmental control and life support. As many space life sciences courses are initiated around the world either by space agencies or universities or jointly, there is a need to consider the international, intercultural, and interdisciplinary aspects of such programs. It is argued that the growing knowledge derived from space research should be integrated into the regular teaching of life sciences rather than leaving it confined to a separate field. Teaching of space life sciences is a prime candidate for the application of the new techniques of "cyberspace education", where interactive learning and globalization of the learning process will take a leading place. The experts and student body are dispersed over many nations, research is of necessity conducted on a basis of international cooperation. The conduct of tele-education is discussed and existing information sources and courses are listed.

Biological Science Disciplines↗

Injury prevention. Where are the resources?

According to the Centers for Disease Control (2002), each year nearly 150,000 Americans die from injuries, making injury the leading cause of death among children and young adults and a significant problem for Americans of all ages. Nonfatal injuries account for approximately 114 million physician office visits and 25% of all emergency department examinations. It is estimated that one in four Americans will suffer a potentially preventable injury serious enough to require medical attention (Shienfield Gorin & Arnold, 1998). As injury-prevention advocates, we must address this public health problem with a multidimensional approach that includes the three Es: education, engineering, and enforcement. Professionals from many disciplines, including nurses, physicians, health educators, school teachers, social workers, police officers, firefighters, emergency medical technicians, and coaches, must have accurate information to educate. Education in injury prevention must be a collaborative approach. These injury-prevention leaders must stay informed and knowledgeable of this ever-changing science. This article highlights common injuries, preventive strategies, and resources for injury-prevention information. This information will assist the healthcare provider in finding accurate sources of information concerning injury prevention (Shienfield Gorin & Arnold, 1998).

Accidental Falls↗