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PubMedDate not supplied

Travel counsellors and travel health advice.

BACKGROUND: Travel Counsellors may be a source of health advice to travellers and might influence travellers' decisions to seek consultation from health professionals. We examined the travel health advice that Alberta travel counsellors currently provide their clients and assessed their health knowledge and practices. METHODS: Cross-sectional postal survey of travel counsellors who book international trips identified from a random sample of Alberta travel agencies in 2000. RESULTS: The response rate was 54.4%. Over 80% of respondents routinely provide clients with general health advice, and approximately 70% advise on malaria risk and vaccines required for travel. The risk of malaria was correctly identified by 72% of the respondents who frequently book clients to malarious destinations. Most respondents (79%) thought they should be involved in promoting the health of international travellers. Their preference was to provide health advice to their clients (90%) rather than refer them to a health professional (67%). CONCLUSIONS: A large proportion of Alberta travel counsellors provided travel-related health advice to clients. Their preferred role of counselling rather than referring conflicts with the recommendations of the International Society of Travel Medicine.

Alberta↗
PubMed1993

Laryngeal fracture in a high school football player.

Laryngeal injuries are rare in the athletic setting, but such sports as football, basketball, and hockey often place the athlete in a position to receive blunt trauma to the throat area. Such an injury has the potential of developing into a life-threatening situation. A high school athlete sustained a fractured larynx during a football game. The injury required surgical repair. Unfortunately, because this type of injury is uncommon in sports, many athletic training books do not extensively address soft tissue and cartilaginous injuries to the structures of the anterior neck. Athletic trainers must be able to recognize the signs and symptoms of a laryngeal injury and refer the athlete for immediate medical attention.

Journal Article↗
PubMed1988

Postpartum thyroid dysfunction in Mid Glamorgan.

A high prevalence of postpartum thyroid dysfunction has been reported in several countries, but there have been no systematic studies of its prevalence in Britain. Among a group of 901 consecutive, unselected pregnant women thyroid autoantibodies were detected in 117 (13%) at booking. The clinical course of postpartum thyroid dysfunction, factors associated with its development, and its likely prevalence were defined in 100 of these women with thyroid antibodies and 120 women with no such antibodies who were matched for age. None of the women had a history of autoimmune thyroid disease. Normal reference ranges for thyroid function during pregnancy and post partum were established in the 120 women negative for thyroid antibodies. On the basis of these observations postpartum thyroid dysfunction was observed in 49 (22%) of the 220 women studied, and the prevalence in the total group of 901 women was estimated to be 16.7%. Thyroid dysfunction, mainly occurring in the first six months post partum, was usually transient and included both destruction induced hyperthyroidism and hypothyroidism. The development of the syndrome was significantly related to smoking more than 20 cigarettes a day and the presence of thyroid microsomal autoantibodies at booking. Of the 16 women with a family history of thyroid disease in whom thyroid microsomal autoantibody activity was detectable at booking, 11 developed thyroid dysfunction. Age, parity, presence of goitre at presentation, duration of breast feeding, and the sex and birth weight of the infant were not associated with the development of postpartum thyroid dysfunction. The mood changes experienced by women post partum may in part be associated with altered thyroid function during this time.

Adult↗
PubMed2002

Socio-economic and schooling status of dental undergraduates from six French universities.

OBJECTIVES: The aim of this study was to evaluate the socio-economic status of French undergraduate dental students. METHODS: A 46-item questionnaire was completed by the dental students of six universities between 1992 and 1995. Subjects related to family background, housing, schooling, income, expenditure and participation in student life were investigated. RESULTS: A total of 1192 out of 1207 questionnaires were returned. Both genders had equal access to dental training. The average overall cost of the four last years of the dental course was 30,302 French francs and varied greatly between faculties, as did the number of hours spent at the faculty for lectures, tutorials and practicals, and clinical work. Overall, the majority of students came from a well off social background, and had a relatively high quality of life while a small minority received no support from their families. Thirty-four per cent of students had never worked. One third of students smoked and one third regularly consumed medication of some sort. A third did not participate in any sport. Only 25% students bought dental text books and 42% of the students reported using the library regularly. CONCLUSIONS: This study offers an accurate description of the socio-economic status of French dental students that could be used as a reference for comparable studies in other European countries.

Adult↗
PubMedDate not supplied

[Combined test in the first trimester of pregnancy in 3,316 unselected pregnant patients for diagnosing Down syndrome].

UNLABELLED: The high detection rate (DR) for Down syndrome pregnancies which can be achieved by measuring fetal nuchal translucency (NT) early in pregnancy can be improved by combining it with placental hormones (PAPP-A, f beta hCG) and maternal age ("combined test"). In this study we wanted to assess the DR using the "combined test" in an unselected population of self-referred pregnant women at a false positive rate (FPR) of about 5%. MATERIALS AND METHODS: NT, PAPP-A, f beta hCG and maternal age were measured in all women with singleton pregnancies who booked for delivery in our hospital from 1.12.97 to 31.12.99 and who were between 10 and 13 completed weeks of gestation (crown-rump-length 35-70 mm). Calculation of the specific Down risk was done with the computer program Alpha, Version 5aa (Logical medical systems, London). RESULTS: A total of 3316 women were tested. Out of 10 Down pregnancies, which occurred in this period of time 9 could be detected with the test. 137 women had a positive test result but a non-Down pregnancy (FPR 4.1%). CONCLUSIONS: The combined test is an excellent test for the detection of Down syndrome pregnancies in a low-risk population. DISCUSSION: The constant increase in maternal age at the time of delivery can also lead to an improved DR if a simple age dependant protocol for Down-detection is used, but only at the price of a much higher number of amniocenteses and subsequent abortions. The DR for Down syndrome can be increased much more markedly using the "combined test" at a much lower FPR (approximately 5%).

Abortion, Eugenic↗
PubMed2006

Sin, sickness, and salvation.

This article seeks to provide commentary and rationale for Orthodox Christian rites and prayers for the sick as found in the Euchologion, or Book of Needs. The reader needs to understand that the prayers of the Orthodox Church prayed at times of sickness and suffering will often strike the non-Orthodox as harsh and even unjust. References to God willing suffering do not sit well with most Western Christians. However, this is the Orthodox Christian belief, and it is expressed in the prayers of the Orthodox Church. Sickness and suffering are understood to be avenues of salvation and a participation in the glory and joys of the resurrection of Christ and life in the Kingdom of God. This is why the Orthodox Church teaches her faithful to accept suffering as something that has the potential to bring them further along in the process of theosis.

Attitude to Death↗
PubMed2005

[Citation analysis of the Chinese Journal of Ophthalmology from 2001 to 2004].

OBJECTIVE: To study the aspects of citation of the Chinese Journal of Ophthalmology and the requirement and utilization of literatures by the scientists working in the field of ophthalmology. METHODS: The citation analysis was used to analyze the references cited in the 926 articles published in the Chinese Journal of Ophthalmology from 2001 to 2004. RESULTS: The citation rate was 91.79% and there were 8.05 citations per article. Citations from journals and books accounted for 91.97% and 7.85% of all citations, respectively. The Price Index was 35.50% and the self-citation rate was 8.40%. The citations from the high-ranked 17 journals accounted for 54.03% of all citations. CONCLUSIONS: The articles cited by papers published in the Chinese Journal of Ophthalmology cover a wide variety of journals. Most citations came from the English journals. The half-citing life is relatively longer and the Price Index is relatively low. It indicates that the authors' ability for using the recently published articles should be improved.

Bibliometrics↗
PubMed1978

Hypospadias.

The principles involved in the two techniques illustrated in this article are safe and effective. Complications can occur, as with any surgical procedure, but they can be minimized with careful attention to detail. In this, as in most discussions of technique, many small details are not included. Therefore, the reader is warned against embarking on repairs with the book in front of him in the operating room. The illustrations serve only as a guide and offer various degrees of assistance, depending upon the amount of the surgeon's experience. The list of references that follows is a fascinating tour of the development of hypospadias surgery, and is recommended reading.

Abnormalities, Multiple↗
PubMed1994

Lyme disease, Rocky Mountain spotted fever, ehrlichiosis: emerging and established challenges for the clinician.

OBJECTIVE: The goal of this review is to facilitate the management of patients with tick-associated diseases. This article will discuss the epidemiology, clinical diagnosis, and antimicrobial therapy of Lyme disease, Rocky Mountain spotted fever, and ehrlichiosis. DATA SOURCES: References are limited to the English language and extend back to the beginning of the twentieth century. The human and veterinary literature were reviewed. Sources include computerized databases and bibliographies of recent articles and books. STUDY SELECTION: Papers were selected on the basis of their timeliness, explanation of important findings by major investigators, extrapolation of clinical data from large patient populations, and clarification of controversial issues. Approximately 50% of the articles initially reviewed are included in the bibliography. RESULTS: Standardization of laboratory testing for Lyme disease should facilitate more accurate diagnosis in the future. Clinical diagnosis of Rocky Mountain spotted fever and ehrlichiosis prior to laboratory confirmation is necessary in order to ensure timely institution of antimicrobial therapy. CONCLUSIONS: Knowledge of endemic regions and seasonal cycles of vectors, varying clinical presentations of disease and appropriate utilization of the laboratory are critical for the appropriate diagnosis and management of patients with tick-associated diseases.

Animals↗
PubMed1996

Providing an acute vascular service: two years experience in a district general hospital.

Provision of acute vascular services is a topical subject for debate, but little has been documented on the total numbers of patients referred urgently to vascular surgeons. With the appointment in Exeter of a second consultant surgeon with a vascular interest, a thorough prospective audit was started of all vascular referrals seen outside the normal outpatient booking system. Between 1 February 1993 and 31 January 1995 a total of 877 such referrals were seen (446 in 1993-94 and 431 in 1994-95). The majority were inpatient referrals (38 percent) and patients seen urgently on the vascular surgical ward at the request of general practitioners (37 percent). The commonest presenting problems were limb ischaemia (42 percent), aortic aneurysms (11 percent) and diabetic foot complications (9 percent). The majority of patients were managed non-operatively. The commonest surgical procedure was amputation (in 8 percent), while 6 percent had grafts for aortic aneurysm, 4 percent grafts for ischaemia, 3 percent embolectomy, and 2 percent graft thrombectomy or revision. The two vascular surgeons were involved in out-of-hours operating substantially more than all but one of their general surgical colleagues, despite their reduced commitment to general surgical 'takes'. These figures document the substantial numbers of urgent referrals seen by vascular surgeons, many of which might well remain unrecorded in workload figures, because of the circumstances in which they are seen. We present the details of our arrangements for urgent vascular cover, and discuss the possible alternatives.

Acute Disease↗
PubMed2000

Internet resources for dentistry: computer, Internet, reference, and sites for enhancing personal productivity of the dental professional.

At the onset of the new millennium the Internet has become the new standard means of distributing information. In the last two to three years there has been an explosion of e-commerce with hundreds of new web sites being created every minute. For most corporate entities, a web site is as essential as the phone book listing used to be. Twenty years ago technologist directed how computer-based systems were utilized. Now it is the end users of personal computers that have gained expertise and drive the functionality of software applications. The computer, initially invented for mathematical functions, has transitioned from this role to an integrated communications device that provides the portal to the digital world. The Web needs to be used by healthcare professionals, not only for professional activities, but also for instant access to information and services "just when they need it." This will facilitate the longitudinal use of information as society continues to gain better information access skills. With the demand for current "just in time" information and the standards established by Internet protocols, reference sources of information may be maintained in dynamic fashion. News services have been available through the Internet for several years, but now reference materials such as online journals and digital textbooks have become available and have the potential to change the traditional publishing industry. The pace of change should make us consider Will Rogers' advice, "It isn't good enough to be moving in the right direction. If you are not moving fast enough, you can still get run over!" The intent of this article is to complement previous articles on Internet Resources published in this journal, by presenting information about web sites that present information on computer and Internet technologies, reference materials, news information, and information that lets us improve personal productivity. Neither the author, nor the Journal endorses any of the sites or products listed, but include these references and links as a matter of convenience for its readers.

Dentistry↗
PubMed2006

Cranio-maxillofacial surgery in Corpus Hippocraticum.

INTRODUCTION: Knowledge of the medical thoughts and practice through the ages constitutes a particular qualification for every practicing physician and surgeon, in order to become a participant of Medicine's continuity and a conscientious practitioner. Cranio-Maxillofacial Surgery constitutes a significant part of the surgical writings of Corpus Hippocraticum. MATERIAL AND METHOD: The original texts of the Hippocratic Collection written in ancient Greek, as they were published along with a translation into modern Greek in G. Pournaropoulos 'Hippocrates' Works', (edited by A. Martinos), Athens 1968, were studied for any account referring to Oral and Maxillofacial Surgery. RESULTS: The medical views and opinions of Hippocrates regarding Cranio-Maxillofacial Surgery and Pathology in particular, as well as Dental Medicine in general, are disseminated in the various books of Corpus Hippocraticum, and although they are almost 3000 years old, they are still in line with current thinking to a great extent. The scope of Hippocratic perspicacity and experience regarding Oral and Cranio-Maxillofacial Surgery includes dentoalveolar surgery, orofacial infections, maxillofacial trauma, dentofacial abnormalities and orthognathic surgery, as well as cranio-maxillofacial injuries. CONCLUSION: Corpus Hippocraticum in spite of time remains a unique and unrivalled work, where one can realize the power of observation, sagacity and the clinical judgement of Hippocrates regarding every aspect of Medicine, and in particular Cranio-Maxillofacial Surgery.

Craniofacial Abnormalities↗
PubMed1999

Twelve-step and mutual-help programs for addictive disorders.

Psychiatrists may wonder why both addiction treatment and the 12-step programs recommend abstinence. In his 50-year follow-up of two groups of alcoholics, Vaillant compared those who established secure abstinence with those who continued to drink. Secure abstinence was associated with: Living longer Better mental health Better marriages Being more responsible parents Being successful employees In considering the various routes to secure recovery, Vaillant recommended that clinicians: Offer the patient a nonchemical substitute for alcohol Remind the patient ritually that even one drink can lead to pain and relapse Repair the social and medical damage that the patient has experienced Restore the patient's self-esteem The preponderance of the research data now available indicates that the 12-step programs of AA, NA, Cocaine Anonymous, and Al-Anon are most helpful for alcohol-dependent and other drug-addicted patients as they seek to achieve secure, long-term abstinence. A growing number of clinicians is recommending that physicians become more knowledgeable and skilled in referring and supporting patients in working 12-step programs of recovery. Specific recommendations include: 1. Be familiar with 12-step activities and tools. These include meetings, home groups, sponsors, the Twelve Steps and Twelve Traditions, books, pamphlets, and slogans. To be able to discuss the meanings and applications of these tools for recovery is useful. Physicians can select those that are most suitable for the individual, recognizing that meeting attendance might not be the most important activity. 2. Support referral by facilitating a meeting between the patient and a temporary contact from the 12-step program. This means becoming familiar with local 12-step programs. Phoning the local AA or NA central office or hot line makes connecting patients to someone who will take them to a meeting that same day possible. AA and NA have committees whose members are interested in working with physicians to help get patients to meetings and to get information to physicians. These are the Cooperation with the Professional Community, Treatment Facilities, and Hospitals and Institutions committees. 3. Work with the resistance of patients. Many addicted patients are resistant to the idea of attending 12-step or mutual-help programs. Reminders of their painful personal database associated with the use of alcohol or other drugs can help break through denial. Involvement of family members and friends in the network therapy developed by Galanter can be effective in reducing resistance. Being patient and persistent in developing the therapeutic alliance helps to maintain contact during the first difficult year of recovery. Physicians should be prepared to work with patients as long as necessary to stabilize their sobriety. Zweben has suggested ways psychotherapy can help deepen work with the steps. 4. Help dual diagnosis patients understand AA's and NA's singleness of purpose. These programs work only with addiction; they do not try in any way to deal with other mental disorders. All patients have to say is, "I want to stop drinking or using drugs," and they will be welcomed and accepted at meetings (see Tradition 3). If they talk only about their psychiatric symptoms or medications, someone may suggest that they go elsewhere for help. Occasionally, well-intentioned AA or NA members tell patients to stop taking their medications. The authors always direct patients to the pamphlet The AA Member: Medications and Other Drugs. This pamphlet tells AA members not to play doctor and to take the medications their doctors prescribe. Copies of the pamphlet are widely available at many AA meetings, or they can be ordered by physicians from Alcoholics Anonymous World Services, General Service Office, Box 459, Grand Central Station, New York, NY 10163 (212-870-3400). 5. Get comfortable with the spiritual dimensions of healing. Zweber and Brown offer good suggestions for getting com

Alcohol-Related Disorders↗
PubMed1982

Frieda Fromm-Reichmann discusses the "Rose garden" case.

In December 1956, Frieda Fromm-Reichmann was invited to give a lecture at the Ypsilanti Psychiatric Institute. It may have been the last lecture she gave, and it certainly was the last lecture that was recorded. Several years later, when I was invited to the same place, we talked about Fromm-Reichmann, and they gave me a copy of the tape. The transcription of the tape appears below. In a few places it has been necessary to indicate that sections of the tape are inaudible. Material in brackets is an approximation of that on the tape. This lecture is based on Fromm-Reichmann's notes for a book she had hoped to write on the treatment history of an adolescent patient--the patient who later wrote I Never promised you a Rose Garden under the name of Hannah Green. In 1955-56, when Fromm-Reichmann was at the Center for Advanced Study in the Behavioral Sciences in Palo Alto, California, she planned to write the book, including material prepared by the patient herself, but she was sidetracked by many other activities and did not finish it. I know that she worked on the book while in Palo Alto, but I do not know what happened to the manuscript. The patient, however, had done her part, and when Fromm-Reichmann speaks of the patients' "treatment history" she is referring to the patient's manuscript, which I read at that time. The patient's version of the "treatment history" provided some of the material for her later novel. This "history" is different from occasional written notes, which are also mentioned in the text of the lecture.

Adolescent↗
PubMed1964

HELPING THE SMALLER LIBRARY.

On invitation, we approach, as consultants, the problem of helping a smaller library. Once we are certain we are qualified for the assignment, we arrange to visit the library and see its problems of personnel, space, and book collection. Talking with personnel operating the library may indicate appropriate courses of action. We recommend library procedures and systems commensurate with the present needs and future growth of a given institution or organization. We appreciate the quantity and quality of services rendered by small libraries. We learn who the readers are and what material is available locally before making recommendations concerning budgets or purchases. Our suggestions on technical matters include either work samples or references. We do not confuse library personnel with great detail. We tell them about local and nearby resources, services of the National Library of Medicine, and the Medical Library Association. We make them feel free to request further information as needed.

Book Collecting↗
PubMed1992

Thyroxine dosage during pregnancy in women with primary hypothyroidism.

OBJECTIVE: To assess whether pregnancy changes the thyroxine requirements of hypothyroid women. DESIGN: A retrospective, longitudinal study. SETTING: Queen Charlotte's and Chelsea Hospital for Women. SUBJECTS: 32 women referred for antenatal care during 35 pregnancies. MAIN OUTCOME MEASURES: Changes in thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels as pregnancy progresses. RESULTS: In most of the pregnancies (80%), no change in thyroxine dose was required (mean dose 129 micrograms). The mean TSH levels in early (1.8 mU/l) and in late pregnancy (1.5 mU/l) were unchanged (P greater than 0.5). In the remaining pregnancies, thyroxine dose was increased after the first antenatal clinic appointment, on the basis of thyroid function test results, from a mean of 104 micrograms to a mean of 172 micrograms (P less than 0.01). These women had a mean early pregnancy TSH of 12.3 mU/l, which decreased by 95% to 1.3 mU/l (P less than 0.01). CONCLUSIONS: Most of the hypothyroid patients presenting to an antental booking clinic are well controlled in early pregnancy and will remain so throughout pregnancy. The dose of thyroxine does not need to be changed, and further assessments of thyroid function should not be necessary. It is unlikely that the patients were all 'overtreated' before conception, since they were referred to us by a large number of independent doctors. Women who are under-treated before the pregnancy are likely to require both increased thyroxine dose and further thyroid function assays. They can generally be easily detected, biochemically, at the first hospital visit.

Adult↗
PubMed1999

Kangaroo care for well low birth weight infants at Harare Central Hospital Maternity Unit--Zimbabwe.

OBJECTIVE: To describe the experience in a newly established Kangaroo Care Unit (KCU) at a tertiary level hospital and to identify factors associated with poor outcome in this unit. DESIGN: Cross sectional study. SETTING: Kangaroo Care Unit at Harare Central Hospital, Zimbabwe. SUBJECTS: Mothers admitted to the KCU and their well preterm infants. MAIN OUTCOME MEASURES: Discharge home or referral back to the Neonatal Unit (NNU) for conventional care. RESULTS: 613 mother infant pairs were studied from May 1994 to December 1996. The median age for all mothers was 23 years (Q1 = 15, Q3 = 26). Fifty four percent of the infants were female. Median age at admission to KCU was 12 days (Q1 = 1, Q3 = 25). Seventy two percent of infants were discharged home from the KCU. The rest (28%) were referred back to NNU for conventional care. The odds of being referred back to the NNU were significantly higher if the infant was male OR = 1.82 (95% CI: 1.25 to 2.66); if the birth weight was < 1 500 gms OR = 1.52 (95% CI: 1.04 to 2.22); if the admission weight to the KCU was < 1500 grams OR = 2.16 (95% CI: 1.42 to 3.29) or if the age on admission to KCU was 14 days or more OR = 2.15 (95% CI: 1.44 to 3.29). These factors remained significant after adjusting for confounding. Mother's age, parity, booking status or whether admission was during the cold months or not had no significant bearing on the outcome in this unit. Reasons for referral back to NNU included apnoea (27%); respiratory distress (27%); aspiration pneumonia (18%); neonatal jaundice (8%); poor feeding (7%); ill mother (5%); sepsis (4%) and diarrhoea (3%). On multivariate analysis birth weight was the strongest predictor for being referred back to the NNU OR = 10.753 (95% CI: 6.026-19.186). CONCLUSION: Establishment of a KCU at a tertiary level hospital is feasible. Kangaroo care for well preterm infants is suitable for most mothers and their preterm infants. Infants were more likely to be referred back for conventional care if they were male, very low birth weight and if the age at admission was greater than two weeks. Further studies are needed to determine the long term survival of these infants.

Adult↗
PubMed1985

History of blood gas analysis. I. The development of electrochemistry.

In 1982 Poul Astrup, in writing a history of acid base balance and blood gases, invited me to contribute a chapter about the modern period, from 1950 to the present. Astrup's book is scheduled for publication at the end of 1985 by Radiometer Company of Copenhagen; it will be distributed by Munksgaard (Blackwell). The story of blood gas analysis since 1950 is vast: there are some 420 references to methodology and closely related physiology. This "modern" history will appear in the Journal of Clinical Monitoring as a series of essays. This first essay centers on electrochemistry, the basis of modern blood gas analysis, and accordingly examines its roots in more detail. The 17th and 18th century exploration of electricity and gas laws led to the development of thermodynamic electrochemistry in 1887 through the collaborative efforts of van't Hoff, Arrhenius, Ostwald, and Nernst. The importance of the hydrogen ion in biology and in the body's buffering mechanisms was worked out by Henderson, Van Slyke, Barcroft, and many others in the first quarter of this century. The glass electrode became available after 1925, but practical blood pH measurement was introduced in the 1950s by Astrup and Siggaard Andersen. Succeeding essays will concern micro pH methods and base excess analysis, the discoveries of Stow's CO2 electrode and Clark's O2 electrode, the development of oximetry, and related physiology.

Blood Gas Analysis↗