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PubMed2002

The Public Health Statute Modernization National Collaborative: developing a model state public health law.

It is through laws that state governments set forth the policy statements describing their responsibilities and authorities for promoting and protecting the public's health. A number of Turning Point states identified the need for strengthening the legal foundation for their public health systems. The Public Health Statute Modernization National Collaborative is working to address this need by providing a tool for public health law reform in the form of a Model Public Health Act for states.

Communication↗
PubMed2001

In search of the origins of modern surgical pathology.

Pathology is a relatively new specialty in the history of medicine and borrows much from the clinical and basic sciences. The clinicopathologic correlation began with deceased (autopsy) and was later extended to the living (surgical pathology). Although the roots of surgical pathology began during the first half of the 19th century, this distinctive specialty evolved through many subsequent technical and scientific discoveries. This historical review will trace the advances in microscopy, histochemistry, and surgery in the later half of the 19th century and early 20th century that led to the development of modern surgical pathology.

Histocytochemistry↗
PubMedDate not supplied

Diverticulosis and diverticulitis spectrum of a modern malady.

Diverticulosis and diverticulitis are common disorders in modern society and represent different places on the spectrum of diverticular disease. Often called a problem of western civilization, diverticular disease is rare in developing countries. This article provides an overview of the epidemiology of diverticular disease, risk factors, and clinical presentation in varying phases. Differential diagnostic testing and comprehensive management from the medical, surgical, and wound, ostomy, and continence nursing perspectives are also addressed. Nurses play a key role in supporting people with diverticular disease and referring them for appropriate assessment, treatment, and support.

Diverticulitis, Colonic↗
PubMed2006

Young pregnant women's knowledge of modern intrauterine devices.

OBJECTIVE: Modern intrauterine devices (IUDs) are safe, effective, and reversible, but only 2.1% of U.S. women use IUDs. We aimed to estimate young pregnant women's knowledge of IUDs. METHODS: We surveyed 190 women, aged 14-25 years, presenting for prenatal or abortion care about their contraceptive history, plans, and knowledge. We asked if they had heard of IUDs and queried them on IUD characteristics. RESULTS: The women were, on average, 20 years old, 27% had education past high school, and 47% had delivered a child. Half were in prenatal care, and 91% had not planned their current pregnancy. Fifty-two percent wished to wait 4 or more years before their next pregnancy, and 27% did not want to be pregnant ever again. Safety and efficacy were the most important factors in choosing a contraceptive method. Fifty percent had heard of IUDs, 71% did not know about IUDs' safety, and 58% did not know about IUDs' efficacy. Respondents who knew of IUDs were older (21 versus 19 years, P<.001) and more likely to be parous (55% versus 39%, P=.04). CONCLUSION: Young women choosing contraception after a pregnancy would benefit from counseling about the relative safety and effectiveness of IUDs, allowing them to make fully informed contraceptive decisions. LEVEL OF EVIDENCE: II-2.

Adolescent↗
PubMed2003

Hepatitis C and renal transplantation in the era of modern immunosuppression.

Kidneys from donors who are positive for hepatitis C virus (DHCV+) have recently been identified as an independent risk factor for mortality after renal transplantation. However, it has not been determined whether risk persists after adjustment for baseline cardiac comorbidity or applies in the era of modern immunosuppression. Therefore, a historical cohort study was conducted of US adult cadaveric renal transplant recipients from January 1, 1996, to May 31, 2001; followed until October 31, 2001. A total of 36,956 patients had valid donor and recipient HCV serology. Cox regression analysis was used to model adjusted hazard ratios for mortality and graft loss, respectively, adjusted for other factors, including comorbid conditions from Center for Medicare and Medicaid Studies Form 2728 and previous dialysis access-related complications. It was found that DHCV+ was independently associated with an increased risk of mortality (adjusted hazard ratio, 2.12, 95% confidence interval, 1.72 to 2.87; P < 0.001), primarily as a result of infection. Mycophenolate mofetil was associated with improved survival in DHCV+ patients, primarily related to fewer infectious deaths. Adjusted analyses limited to recipients who were HCV+, HCV negative, or age 65 and over, or by use of mycophenolate mofetil confirmed that DHCV+ was independently associated with mortality in each subgroup. It is concluded that DHCV+ is independently associated with an increased risk of mortality after renal transplantation adjusted for baseline comorbid conditions in all subgroups. Recipients of DHCV+ organs should be considered at high risk for excessive immunosuppression.

Adolescent↗
PubMed2006

Celiac sprue (the great modern-day imposter).

PURPOSE OF REVIEW: To review the current epidemiological information on celiac disease and the various presentations and associated. RECENT FINDINGS: Epidemiologic studies reveal celiac disease to be common, occurring in approx. 1% of the population. It is being diagnosed worldwide, even in developing countries. The classic mode of presentation has become less common, with diarrhea or a malabsorption syndrome as the mode of presentation in fewer than 50% of individuals. The other major modes of presentation are iron-deficiency anemia, osteoporosis, screening of family members, or incidentally at endoscopy done for dyspepsia or reflux. Neurological presentations may include peripheral neuropathy or ataxia. Arthritis is commonly found in patients with celiac disease when systematically sought. Patients often have a previous diagnosis of irritable bowel syndrome. Autoimmune diseases occur more frequently (three to ten times more) in those with celiac disease than the general population. However, this increased incidence of autoimmune diseases is not prevented by early diagnosis of celiac disease. SUMMARY: We will review the various associated diseases/presentations of celiac disease. The heterogeneity of the symptoms can make the diagnosis challenging and certainly the great modern-day imposter.

Autoimmune Diseases↗
PubMedDate not supplied

Modern surgical treatment of primary aneurysmal bone cyst of the spine in children and adolescents.

Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor-like condition. Treating children with spinal involvement poses special hazards due to the proximity of the lesion to the spinal cord and the need to preserve spinal stability and balance after surgery. Twelve children with ABC treated between 1990 and 2002 at a tertiary pediatric musculoskeletal tumor center using modern surgical techniques and technology were retrospectively reviewed. A surgical technique using a four-step approach of intralesional curettage, high-speed bur, electrocautery, and bone grafting was found to have a significantly reduced rate of recurrence (0/8 cases) compared with traditional intralesional curettage and bone grafting (4/4 cases) (P < 0.002). Short-segment spinal fusion with instrumentation was also done in five cases immediately after excision of the ABC under the same anesthesia and was a nonsignificant marker for reduced rate of recurrence (P < 0.08), likely secondary to wide exposure. Overall, at last follow-up, all 12 patients were alive and well with no evidence of disease and no significant spinal deformity. The four-step approach to treatment of ABC of the spine with appropriate spinal instrumentation and fusion is recommended for successful treatment of this aggressive lesion.

Adolescent↗
PubMed2006

Implications of exercise test modality on modern prognostic markers in patients with known or suspected coronary artery disease: treadmill versus bicycle.

BACKGROUND: Important modern prognostic markers such as heart rate recovery (HRR), chronotropic index, delayed systolic blood pressure (SBP) response and Duke treadmill score (DTS) have been evaluated by treadmill exercise testing. Their value in bicycle exercise testing is unclear. METHODS: Patients (n=211, age 64+/-10; 75% male) with known or suspected coronary artery disease randomly underwent either bicycle (n=105) or treadmill (n=106) exercise electrocardiography. They were matched for age, gender, body mass index, hypertension, smoking, lipid status, prevalence of diabetes, medication, haemoglobin level, extent of coronary artery disease and left ventricular ejection fraction. RESULTS: Despite a higher peak heart rate (pHR) patients stressed by treadmill had a slower drop in HR during the early phase of recovery with a significantly higher rate of abnormal HRR (pHR; HR 1 min into recovery < or =12 bpm) with 37% in treadmill versus 19% in bicycle (P=0.004). Abnormally delayed SBP response [(SBP 1 min into recovery/SBP 3 min into recovery) >1.0] was also more common in treadmill (41%) compared to bicycle (12%, P<0.001). However, the rate of chronotropic incompetence [(pHR - rest HR)/(220 - age - rest HR) <0.8] was significantly lower in treadmill than in bicycle (60 versus 76%, P<0.001). Mean DTS was also significantly higher in treadmill compared to bicycle (4.8+/-6.5 versus 3.6+/-5.1, P=0.03) mainly due to the higher workload achieved when patients were stressed by treadmill (8.5+/-2.5 versus 6.1+/-1.5 metabolic equivalents, P<0.001). CONCLUSIONS: Further adjustment is needed prior to routine incorporation of these important measures into interpretation of bicycle exercise testing.

Blood Pressure↗
PubMed2005

Air quality, tobacco smoke, urban crowding and day care: modern menaces and their effects on health.

BACKGROUND: The known adverse health effects of outdoor air pollution were reduced in the last century by effective legislation and pollution control. Although combustion of biomass fuels in the indoor environment remains a major hazard in developing countries, there has been a change in the nature of the traffic-generated air pollutants in outdoor air in developed countries. The role of day care and siblings in increasing the risk of infection early in life contrasts with protection from allergic disease later. METHODS: The mechanisms of how these pollutants exert their effects are poorly understood, but there is emerging evidence that the toxic effects may be related to infection. This synopsis discusses the epidemiologic relationship of the menaces of modern living, including air pollution, urban crowding and infection, and will explore some of the mechanisms of how they act synergistically to cause exacerbations of illnesses in individuals with preexisting respiratory conditions, such as asthma. It will also discuss the roles of day care and siblings in relation to respiratory disease risk. RESULTS: Current evidence suggests that much of the morbidity and mortality related to sources of both indoor and outdoor pollution occur by causing or interacting with respiratory infection and other acute or chronic health conditions, such as asthma. CONCLUSION: Improvements in air quality through efforts to tackle environmental problems such as pollution and tobacco smoke will help achieve better health. Day care and siblings increase infectious disease early in life but are associated with protection against development of allergic disease later.

Adolescent↗
PubMed2006

Coverage and use of prescription drugs in nursing homes: implications for the medicare modernization act.

BACKGROUND: The Medicare Modernization Act will affect drug coverage for most nursing home residents in the United States. Understanding the impact of the MMA requires knowledge of the process by which drugs are prescribed to residents and the effect of coverage on medication use. OBJECTIVES: We sought to characterize sources of drug coverage for Medicare beneficiaries residing in nursing facilities and to provide empirical estimates of the relationship between coverage and use. RESEARCH DESIGN: We used bivariate and multivariate analyses to assess the relationship between coverage and drug use in a sample of nursing home residents drawn from the 2001 Medicare Current Beneficiary Survey augmented with monthly institutional drug administration data. SUBJECTS: A total of 789 residents with a mean nursing home stay of 8.7 months in 2001 were studied. MEASURES: We measured the proportions of residents with drug coverage from Medicaid, other sources, or none at all, and mean number of unique prescription drugs administered per resident per month by source of coverage. RESULTS: We found that 20% of the sample had no drug coverage, 56% had drug coverage under Medicaid, 9% had coverage from other sources, and for 15% drug coverage status could not be determined. There were no statistically significant differences in drug utilization by drug coverage status. CONCLUSIONS: When drug coverage becomes a Medicare benefit in 2006, it is unlikely to spur additional medication use among nursing home residents but may redirect utilization as a result of health plan formulary restrictions.

Aged↗
PubMedDate not supplied

A primer on the use of modern missing-data methods in psychosomatic medicine research.

This paper summarizes recent methodologic advances related to missing data and provides an overview of two "modern" analytic options, direct maximum likelihood (DML) estimation and multiple imputation (MI). The paper begins with an overview of missing data theory, as explicated by Rubin. Brief descriptions of traditional missing data techniques are given, and DML and MI are outlined in greater detail; special attention is given to an "inclusive" analytic strategy that incorporates auxiliary variables into the analytic model. The paper concludes with an illustrative analysis using an artificial quality of life data set. Computer code for all DML and MI analyses is provided, and the inclusion of auxiliary variables is illustrated.

Data Collection↗
PubMed2003

Honey-medicated dressing: transformation of an ancient remedy into modern therapy.

Honey has been applied for medicinal purposes since ancient times. Its antibacterial effects have been established during the past few decades. Still, modern medical practitioners hesitate to apply honey for local treatment of wounds. This may be explained by the expected messiness of such local application. Moreover, secondary infectious disease may be caused by contamination of honey with microorganisms. Hence, if honey is to be applied for medicinal purposes, it has to meet certain criteria. The authors evaluated the use and safety of a honey-medicated dressing that was developed to meet these criteria in a feasibility (phase II) study featuring 60 patients with chronic (n = 21), complicated surgical (n = 23), or acute traumatic (n = 16) wounds. In all but 1 patient, it was found easy to apply, helpful in cleaning the wounds, and without side effects. Based on these results, the authors advise to subject this dressing to a randomized, double blind, phase III study.

Adolescent↗
PubMed2005

Posttransplant lymphoproliferative disorders after renal transplantation in the United States in era of modern immunosuppression.

BACKGROUND: Posttransplant lymphoproliferative disorders (PTLD) still represent a major preoccupation after renal transplantation, even in the most recent years. METHODS: We analyzed the incidence, risk, and prognostic factors of PTLD in a cohort of kidney recipients using the United States Renal Data System. RESULTS: Among 25,127 Medicare patients transplanted between 1996 and 2000, 344 developed a PTLD defined as a non-Hodgkin lymphoma (1.4%). History of pretransplant malignancy (adjusted hazard ratio [AHR]=3.54, CI 2.31-5.43), younger age (AHR=1.91, CI 1.18-3.1), fewer HLA matches (AHR=1.32, CI 1.1-1.59) and treatment by ATG (AHR=1.55, CI 1.2-1.99) and OKT3 (AHR=1.37, CI 1-1.76), especially if given for rejection therapy were associated with an increased risk of PTLD. Mycophenolate and azathioprine were associated with a lower risk of PTLD (AHR=0.6, CI 0.47-0.78 and AHR=0.66, CI 0.46-0.95, respectively). IL2-receptor inhibitors and sirolimus did not modify the risk of PTLD. Patients without induction therapy treated with tacrolimus were at greater risk of lymphoma than those treated with new formulations of cyclosporine and those treated with antimetabolites (mycophenolate and azathioprine) have a lower risk of PTLD than those without. Patients with PTLD had poor survival (64% vs. 80% at 5 years). Older age, pretransplant malignancy and OKT3 were risk factors for death whereas treatment with mycophenolate was associated with a better survival (AHR=0.49, CI=0.28-0.82). CONCLUSIONS: Our study highlights the contribution of patient history and immunosuppression in the risk of PTLD in the era of modern immunosuppression.

Adolescent↗
PubMed2006

Modern antiepileptic drugs: guidelines and beyond.

PURPOSE OF REVIEW: Ten antiepileptic drugs have been licensed since 1990. Their usage will be briefly reviewed focusing on new data and inclusion in guidelines. The hypotheses exploring the underlying basis of pharmacoresistance will be presented. RECENT FINDINGS: Lamotrigine, gabapentin, topiramate, and oxcarbazepine are available for use as monotherapy in many countries following comparative studies with older antiepileptic drugs. Zonisamide and pregabalin have recently obtained licences as adjuvant therapy in the US and Europe for partial epilepsy with or without secondary generalization. The UK National Institute for Clinical Excellence guideline has advised, largely based on cost, against the routine use of modern antiepileptic drugs, except when older drugs have failed or are contraindicated. This contrasts with the US guidelines which are less conservative. Surgically resected specimens from patients with refractory epilepsy have led to the development of two hypotheses to explain pharmacoresistant epilepsy. SUMMARY: The introduction of 10 new antiepileptic drugs has provided greater choice for patients and doctors, although evidence in support of their superiority over the older drugs is sparse. This has led to conflicting advice in guidelines. Recent developments in the understanding of pharmacoresistance may explain the relatively high incidence of refractory epilepsy.

Anticonvulsants↗
PubMed2006

The origin of modern crocodyliforms: new evidence from the Cretaceous of Australia.

While the crocodyliform lineage extends back over 200 million years (Myr) to the Late Triassic, modern forms-members of Eusuchia-do not appear until the Cretaceous. Eusuchia includes the crown group Crocodylia, which comprises Crocodyloidea, Alligatoroidea and Gavialoidea. Fossils of non-crocodylian eusuchians are currently rare and, in most instances, fragmentary. Consequently, the transition from Neosuchia to Crocodylia has been one of the most poorly understood areas of crocodyliform evolution. Here we describe a new crocodyliform from the mid-Cretaceous (98-95 Myr ago; Albian-Cenomanian) Winton Formation of Queensland, Australia, as the most primitive member of Eusuchia. The anatomical changes associated with the emergence of this taxon indicate a pivotal shift in the feeding and locomotor behaviour of crocodyliforms-a shift that may be linked to the subsequent rapid diversification of Eusuchia 20 Myr later during the Late Cretaceous and Early Tertiary. While Laurasia (in particular North America) is the most likely ancestral area for Crocodylia, the biogeographic events associated with the origin of Eusuchia are more complex. Although the fossil evidence is limited, it now seems likely that at least part of the early history of Eusuchia transpired in Gondwana.

Alligators and Crocodiles↗
PubMed2005

The development of modern metrology and its role today.

Modern metrology is the result of more than 200 years of development that began with the creation of the decimal metric system at the time of the French Revolution and the beginning, at about the same time, of mass production using interchangeable parts. This article traces these developments and describes how world metrology is organized today and gives examples of applications of metrology showing how it concerns us all in many aspects of our daily life.

International System of Units↗
PubMed2006

Fatal attraction: living with earthquakes, the growth of villages into megacities, and earthquake vulnerability in the modern world.

The great earthquake belt which stretches from the Mediterranean through the Middle East into Central Asia results from the ongoing collision between the Eurasian plate and the African, Arabian and Indian plates to the south. Through much of this belt, the topography is created and controlled by fault movement in earthquakes. Many habitations are located at the foot of the fault-controlled mountain range-fronts that bound inhospitable deserts or elevated plateaus, in positions that are favourable for trade-routes, strategic control of access or for water supply. As a result, they are vulnerable to earthquakes, which often seem to have targeted population centres precisely. For many centuries, an uneasy accommodation was reached between human needs and the earthquake-controlled landscape, sometimes brilliantly exploited by local hydrological engineering, as in Iran. Occasional earthquakes would occur, killing a shocking proportion of the population, but the populations of the settlements themselves would be relatively small. Many once-small rural communities have now grown into towns, cities or megacities, while retaining their vulnerability through poor building standards. Earthquakes that occur in these places today now kill many more than they did in the past, as we have witnessed in the last few years. Extreme catastrophes have been rare only because the exposure of modern megacities to earthquake hazards has been relatively short (approx. 50 years); an increase in the number of such catastrophes now seems to be inevitable.

Disaster Planning↗
PubMed1992

Uranium-series dating and the origin of modern man.

Uranium-series dating is based on measurement of the radioactivity of short-lived daughter isotopes of uranium formed in samples which initially contained only the parent uranium. Materials suitable for U-series dating are found in many prehistoric archaeological sites, and include stalagmitic layers (flowstones), and spring-deposited travertines. Some marls and calcretes are also datable using isochron methods, whereas dates on molluscan shells, bones and teeth are less reliable. Ages obtained using alpha counting to determine isotope ratios have errors greater than 5%, and can range from 1 to 350 ka. Mass spectrometric methods slightly increase the range (0.1-500 ka) but greatly decrease the error to less than 1%, making this the optimal method for high-precision dating of the origin of modern man.

Animals↗