High risk

To behave in an adaptive way an animal must refer to information. Consider what happens when a motorist comes to traffic lights at red. The motorist usually stops. Stopping avoids the high risk of damage and injury at the cost of one or two minutes. So stopping at red traffic lights is the best way for the motorist to behave.

The use of simulation and team training has become an excellent tool to reduce errors in high-risk industry such as the commercial airlines and in the nuclear energy field. The health care industry has begun to use similar tools to improve the outcome of high-risk areas where events are relatively rare but where practice with a tactical team can significantly reduce the chance of bad outcome. There are two parts to this review: first, we review the rationale of why simulation is a key element in improving our error rate, and second, we describe specific tools that have great use at the clinical bedside for improving the care of patients. These cross different (i.e. medical and surgical) specialties and practices within specialties in the health care setting. Tools described will include the pinch, brief/debriefing, read-backs, call-outs, dynamic skepticism, assertive statements, two-challenge rules, checklists and step back (hold points). Examples will assist the clinician in practical daily use to improve their bedside care of children.

Objectives To analyse the sources and reasons for referral of women who have undergone genital mutilation to a recently established specialist clinic, and to determine the consequences of the genital mutilation procedure. ... Setting The maternity units of Guy's and St. Thomas's ...

Background Few studies have examined the psychopathological profiles of child offspring of bipolar parents. Such investigations are useful as a first step to identifying potential prodromal manifestations of bipolar disorder. Methods The presence of psychopathology ...

Set temperature, 35°C AH (mgH 2 O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 RH (%) 83.7 ± 1.0* 97.7 ± 1.4 93.2 ± 1.5 Set temperature, 37°C AH (mgH 2 O/l) 34.5 ± 1.6* 38.7 ± 2.2 † 43.1 ± 1.1 RH (%) 91.8 ± 3.2 87.7 ± 7.4 † 94.6 ± 0.9 *P < 0.05 vs DAR HC and MR 730, † P < 0.05 vs MR 730.

From September 1977 to November 1987 high-risk (i.e. with positive axillary lymph nodes, or tumor size >5 cm or skidfascia invasion) premenopausal and menopausal breast cancer patients have been included in 2 randomized trials. In both trials the primary surgical treatment was total mastectomy with axillary sampling. In the first trial (DBCG 77-B) 1034 patients all received postoperative radiotherapy (RT) and were further randomized to 1) no systemic treatment (O), 2) cyclophosphamide (C), or 3) cyclophosphamide + methotrexate + 5-fluorouracil (CMF). The chemotherapy was given for 1 year. With a median observation time of 7 years the actuarial survival after 9 years is 50, 60 and 65% respectively. Retrospectively, the survival benefit was observed to be most pronounced in patients with tumor size C5 cm and with <3 positive lymph nodes. In the subsequent study initiated in 1982 (82-B) all patients received CMF for 9 months. Furthermore they were randomized to 1) RT, 2) no further treatment, or 31 tamoxifen (TAM) for 1 year. As of November 1, 1987, 1308 patients have been included. At 4 years and with a median observation time of 2 years the survival is similar in the 3 groups. In conclusion, in high-risk premenopausal and menopausal patients adjuvant chemotherapy combined with RT resulted in a 20-30% relative reduction in mortality at 9 years compared with RT alone. Preliminary analysis of adjuvant CMF + RT, compared with CMF alone or with CMF + TAM, shows after a median observation time of more than 2 years no significant survival differences.

Objectives. Women with functional limitations face obstacles in adhering to established mammography guidelines owing to personal factors and barriers within the health care system. Whereas some studies have focused on either physical or cognitive limitations that correlate with lower rates of cancer screening, this study examined multiple functional limitations (physical, psychological, and sociability) and mammography screening. Methods. Data from the 2000 National Health Interview Survey were analyzed for 9,505 women aged 40 years. We hypothesized that women with functional limitations (physical, psychological, and/or sociability) are less likely to receive screening mammography. Access variables (insurance coverage and usual source of health care) and utilization variables (physician contact and receipt of clinical breast examination) were included. Using multiple logistic regression (MLR), we estimated the relative contribution of functional limitations on mammography use after accounting for sociodemographic characteristics and confounding variables. Results. An estimated 34.6% of women had physical limitations, 16.1% sociability limitations, and 8.1% psychological limitations. After controlling for all other variables, MLR analysis indicated that women with moderate or severe sociability limitations were less likely than their unimpaired counterparts to utilize mammography (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.48-0.81). Interestingly, women with severe physical limitations were more likely than physically able women to utilize mammography screening (OR, 1.28; 95% CI, 1.07-1.53). Women with no insurance, no usual care, and no doctor's visit within the past year were substantially less likely to use mammography screening. Conclusions. Sociability limitations, lack of access to health care, and limited regular checkups played significant roles in underutilization of screening mammography.

The main problem in the guidance of Autonomous Mobile Robots is obstacle avoidance in unknown environment. This paper presents a novel technique for path fixing for obstacle avoidance using a framework of cellular logic. The images of the unknown environment obtained from local perception devices are scanned by an array of neighbourhood windows and processed by the techniques of contouring, skeletonizing and centroid determination. High risk regions and low risk regions are considered for nearby and distant obstacles. A framework of cellular logic is used to determine the probability of collision. The various possibilities are classified into equally likely classes. The optimal path is the one that has the common probability of collisions. The mission direction is accordingly fixed instantaneously to meet the challenge of obstacle avoidance.

The paper presents the results of research aimed at developing a risk assessment process that can be used to more thoroughly characterise risks associated with loader-and dozer-related fatal incidents in US mining. The assessment is based on historical data obtained from the US Mine Safety and Health Administration investigation reports, which includes 77 fatal incidents that occurred from 1995 to 2006. The Preliminary Hazard Assessment method is used in identifying and quantifying risks. Risk levels are then developed using a pre-established risk matrix that ranks them according to probability and severity. The resulting assigned risk value can then be used to prioritise risk control strategies. A total of 10 hazards were identified for loaders. The hazards 'failure to follow adequate maintenance procedure' and 'failure of mechanical/electrical/hydraulic components' were the most severe and frequent hazards and they fell into the category of 'high' risk. The same number of hazards was identified for dozers. The hazard 'failure to identify adverse site/geological conditions' was the most severe and frequent hazard and it fell into the category of 'high' risk.

contributed to writing the review of literature and introduction. Adeline Nyamathi, and Mary Marfisee contributed to the methods and discussion. Allan Cohen, Kamala Nyamathi, Viviane de Castro and Daniel George contributed to the editing and final review of the manuscript. Barbara Leake provided the statistical analysis. All authors approved the final paper.

To identify predictive factors of complete and age-appropriate vaccination status in Greece, we conducted a cross-sectional study, using stratified cluster sampling, among children attending the first year of the Greek Grammar school (about 6 years of age) and their parents/guardians. Almost 88% (N = 3878) of pupils in the selected clusters (school classrooms) provided their vaccination booklet and their parents/guardians completed a questionnaire regarding beliefs and attitudes towards immunization. Belonging to a minority group, having other siblings and perceiving long distance to immunization site as a barrier were independent predictors of both incomplete and delayed vaccination status in the final logistic regression model. Maternal age ≥ 30 years and the perception that natural disease is preferable to vaccination were associated with complete vaccination, whereas paternal education of high school or higher was the other independent determinant of age-appropriate immunization. Socioeconomic factors rather than parental beliefs and attitudes towards immunization explained underimmunization. Further interventions are warranted to enhance vaccine coverage in high-risk groups identified in this study.

A PCR procedure for the discrimination of Burkholderia mallei and Burkholderia pseudomallei was developed. It is based on the nucleotide difference T 2143 C (T versus C at position 2143) between B. mallei and B. pseudomallei detected in the 23S rDNA sequences. In comparison with conventional methods the procedure allows more rapid identification at reduced risk for infection of laboratory personnel.

Objective To test a theoretical model examining processes through which a parent-focused educationalbehavioral intervention [Creating Opportunities for Parent Empowerment (COPE)] relates to children's posthospital adjustment problems. Methods Mothers (n ¼ 143) and their 2-7-year-old children, unexpectedly hospitalized in two pediatric intensive care units, were randomized to COPE or control conditions. Maternal measures included parental beliefs, anxiety, negative mood, and child adjustment 3 months post discharge. Observers rated maternal support of their children during hospitalization. Results Structural equation modeling suggested that the model tested provided a reasonable fit to the data [w 2 (97 df) ¼ 129.43; p ¼ .016; root mean square error of approximatio n ¼ .048; comparative fit index ¼ .95]. COPE effects on children's post-hospital externalizing behaviors were indirect, via associations with parental beliefs and maternal negative mood state. Furthermore, COPE participation was associated with more maternal support of their children, which was also associated with less internalizing and externalizing behaviors 3 months post discharge. Conclusion Implementing COPE may help avert future mental health problems in this high risk population. Understanding the processes by which an already empirically validated program relates to child outcomes is likely to aid clinicians and administrators in the widespread uptake of the COPE program.

This paper frames juvenile justice as a public health concern and articulates a public health approach to intervention with incarcerated youth. The authors review the founding principles of juvenile justice and examine current practices through the lens of public health concepts. Although the knowledge base is incomplete, existing literature suggests dismal outcomes including high recidivism and low productivity; it also reveals promising evidence-based practices that require ongoing scrutiny and continuing elaboration. The authors' main recommendation concerns the application of a three-tiered prevention logic model that encompasses appropriate, evidence-based interventions, national implementation, and empirical validation. We advocate comprehensive, coordinated planning models that focus on outcomes, operate under shared infrastructure, and incorporate data analysis. The transformation of the juvenile justice system will require careful coordination, improved data systems, and multiple levels of focus. We assert that, despite the numerous challenges facing today's juvenile justice system, incarceration presents an opportunity for youth rehabilitation through effective interventions. Systemic reform has the potential both to improve outcomes for youth and to accrue public benefit through crime reduction and cost efficiencies.

Summary A cute liver failure (ALF) patients have a high risk of mortality. The elective treatment for ALF still is orthotopic liver transplantation. Donor organ scarcity and the associated high costs make transplantation possible for only about one third of the patients on the transplantation waiting list. Engineering a biological liver substitute is an interesting alternative to the traditional ALF

We review the risk and protective factors for child physical abuse (CPA). An etiological model based on moderate to strongly supported risk factors would begin with distal perpetrator variables of being abused as a child/teen and receiving less family social support as a child. Next might come current family variables such as parents' youth, father's drinking, and family's living in a community that is impoverished and/or has a lower percentage of two parent families. More proximal variables that increase the probability of parents, especially mothers, employing severe or abusive physical tactics could include mothers' dysphoria (e.g., unhappiness, emotional distress, anxiety, loneliness and isolation, depression, somatic complaints, interpersonal problems, feelings of incompetence as a parent, a tendency toward becoming upset and angry), and stress (more stressful life events, including parenting and other family stresses) and coping (most likely a protective factor, including problem solving and social support). Finally, risk factors that are proximal to abuse could include mothers' high reactivity (impulsivity, high negative affect and autonomic nervous system arousal), high-risk parenting (harsh discipline strategies, verbal aggression, yelling), and negative attributions, and children's behavior problems (e.g., socialized aggression, attention deficits, and internalizing and externalizing problems).

Background-Inflammatory glaucoma is still a diagnostic and therapeutic dilemma and surgical intervention is always associated with a high risk of failure or reactivation of the inflammatory disease. In this study we prospectively examined the value of transscleral diode laser cyclophotocoagulation (TDLC) for the treatment of refractory inflammatory glaucoma. Methods-22 eyes of 20 consecutive patients with inflammatory, medically uncontrollable, glaucoma secondary to chronic uveitis/trabeculitis (n = 18), chemical injury (n = 2), episcleritis (n = 1), and necrotising scleritis with inflammation (n = 1) were treated by TDLC. Nine eyes (41%) had had previous failed glaucoma surgery (trabeculectomy, cyclocryocoagulation) and 15 eyes (68.2%) had had previous anterior segment surgery. All patients were followed for 1 year after the initial treatment. Results-Within 12 months of the first treatment the intraocular pressure was controlled in 77.3% of all eyes (72.2% of those with uveitic glaucoma). No serious side eVects such as activation of the inflammatory process, phthisis bulbi or persistent hypotonia were observed, except one patient with a temporary fibrin reaction. More than one treatment was necessary in 63.6% of the patients. The use of systemic carbonic anhydrase inhibitors was reduced from 68.2% before treatment to 27.3% after 1 year. Conclusion-TDLC seems to be a safe and eVective procedure for the treatment of inflammatory glaucoma and may become an alternative to trabeculectomy with antimetabolites in uveitic glaucoma. TDLC may become the surgical procedure of choice in treating secondary glaucoma caused by chemical injury and also in scleritis associated glaucoma, using reduced parameters for application.

Roel A. M. Heesakkers, MD Gerrit J. Jager, MD, PhD Anke M. Hövels, MSc Bartjan de Hoop, MD Harrie C. M. van den Bosch, MD Frank Raat, MD J. Alfred Witjes, MD, PhD Peter F. A. Mulders, MD, PhD Christina Hulsbergen van der Kaa, MD, PhD Jelle O. Barentsz, MD, PhD Purpose: To prospectively evaluate the feasibility of magnetic resonance (MR) imaging with ferumoxtran-10 in patients with prostate cancer to depict lymph node metastases outside the routine pelvic lymph node dissection (PLND) area.

Objective. To examine whether participating in a pressure ulcer prevalence survey and receiving feedback results in an improvement in quality of care. Design. Cross-sectional studies from 1998 to 2002 were compared over time. Setting. Sixty-two acute care hospitals in the Netherlands. Study participants. Patients hospitalized at the moment of the surveys. Interventions. Each hospital was given hospital-specific performance data and national aggregate data, and peer comparisons to improve the quality of care. Main outcome measures. The case-mix-adjusted prevalence of pressure ulcers of grade ≥2, the percentage of high-risk patients receiving adequate prevention, and the total number of enabling conditions present were compared between successive surveys using multi-level analysis, in order to estimate a linear trend model and trend differences for each hospital. Results. The case-mix-adjusted prevalence of pressure ulcers decreased over the 5-year period, while the percentage of patients receiving adequate prevention and the total number of enabling conditions present increased. The total number of enabling conditions had a significant effect on the decrease in case-mix-adjusted prevalence: more enabling conditions led to a lower case-mix-adjusted prevalence (χ 2 = 125; degrees of freedom = 1; P < 0.00). The percentage of patients receiving adequate prevention also had an effect on the change in case-mix-adjusted prevalence, with a higher percentage leading to a lower casemix-adjusted prevalence. This effect, however, was not significant. Conclusions. Monitoring prevalence and giving feedback results in an improvement in quality of care in terms of pressure ulcer prevention. It is very important to continue conducting surveys to avoid attention moving away from this topic, which may in turn lead to a deterioration in the quality of pressure ulcer care. Further research to find the most effective feedback approach is needed.

A pesar de que la infertilidad presenta una serie de peculiaridades en comparación con el resto de las enfermedades crónicas (no hay sintomatología asociada, no hay limitaciones físicas, no representa una amenaza para la supervivencia), su diagnóstico y tratamiento genera alteraciones emocionales similares a las de otras afecciones médicas. En este artículo, revisamos la naturaleza, la prevalencia y el curso de las mismas a lo largo del proceso de diagnóstico y tratamiento de reproducción asistida, resaltando la elevada variabilidad interindividual, la necesidad de diferenciar entre desajuste emocional y alteración psicopatológica, la existencia de un elevado porcentaje de parejas que no padecen dichas alteraciones o que disponen de los recursos adaptativos necesarios para superarlas y, por último, la conveniencia de profundizar en las variables que nos ayuden a detectar a las parejas de "alto riesgo". Palabras claves: Infertilidad, Psicopatología, Alteración emocional, Ansiedad, Depresión. Although infertility has some unique characteristics when compared to other chronic diseases (there are no associated symptoms, no physical limitations and there is no threat to survival), its diagnosis and treatment causes emotional disorders similar to those of other medical conditions. In this paper we review the nature, prevalence and process of such emotional disorders during the diagnosis of infertility and the treatment with assisted reproduction techniques. We emphasize the high interpersonal variability, the need to differentiate between emotional maladjustment and psychopathological disorder, and the existence of a high percentage of couples without emotional disorders or with adaptive resources to cope with infertility. Finally, we stress the need for further studies that would allow the identification of "high risk" couples.

The spatial distributions of contaminant metals (Hg, Pb, Zn, Cd, Cu) and a metalloid (As) in vegetable plots and paddy fields located near a large scale Pb/Zn smelter in Hunan province, China, were investigated. Soil located 4 km from the smelter was severely contaminated, with maximum concentrations of Hg, Pb, Zn, Cd, Cu and As as high as 2.89, 1200, 3350, 41.1, 157 and 93 mg kg À1 , respectively. Concentrations of soil metal and As decreased with distance in the dominant wind direction. Single-factor assessment indicated pollution levels of Hg, Pb, Zn and Cd were most severe, while pollution levels for Cu and As were less severe. Results from a potential ecological risk assessment indicated high risk associated with the soil within a 4 km radius, with the contribution for each contaminant calculated as follows: Cd (70.0%), Hg (19.4%), Pb (4.8%), As (3.0%), Cu (1.7%) and Zn (1.1%). The forest soil in the nearby city park was also affected by the atmospheric depositions from smelting activities. Soil profiles demonstrated the pollutants were mostly accumulated in the upper 20 cm layer. Contamination of the topsoil with Hg, Pb, Zn, Cd, Cu and As indicated remediation should be considered.

There is a large consensus among academics and practitioners that ICT investments should be carefully justified, measured and controlled. In practice, the traditional capital investment appraisal techniques (CIAT's) such as payback period or net present value are by far the most used techniques. Nevertheless, serious doubts about the fitness of these techniques in an ICT environment arise. ICT investments have special characteristics (high risks, LT-return, large proportion of intangible/hidden costs and benefits.. .) which makes the use of these techniques very difficult and the reliability of the outcome most uncertain. Efforts are made to find more appropriate techniques. CIAT's are adjusted so that these techniques become more reliable in an ICT environment. New justification methods/techniques are developed. However neither these adjusted techniques nor the new techniques are frequently used. This might be explained by the fact that the outcome of these techniques is difficult to interpret and to use and the fact that some significant problems (like the estimation of hidden costs) remain unsolved. Moreover, most of the new techniques are still in the conceptual phase. Despite the existence of a wealth of literature, the IS community appears to be no nearer to a solution to many problems associated with ICT appraisal. Since all techniques presented in the article have their drawbacks, it is safe to say that reliance on a sole technique may lead to sub-optimalisation or even failure. Therefore it makes sense to use a mixture of techniques, eliminating or diminishing the weaknesses of each of the techniques used. We strongly recommend a multi-layer evaluation process, or an evaluation process derived from the balanced scorecard, for the appraisal of major ICT investment projects.

Translate the available knowledge on ageing and dehydration into main messages for clinical practice. Older people are more susceptible to dehydration than younger people. This is partly due to lack of thirst sensation and changes in the water and sodium balance that naturally occur as people age. It is also, to some degree, attributable to the fact that elderly people, both those living at home and those living in institutions, often have various impairments, disabilities and/or handicaps (comorbidity). They also tend to use numerous drugs and medication for these illnesses (polypharmacy). Multimorbidity and polypharmacy often overstress the normal age-related physiological changes in the water and sodium balance and therefore increase elderly people&#39;s risk of dehydration,especially during intercurrent infections or warm weather. Elderly people, whether they are living on their own or in an institution, and especially elderly people that can no longer take care of themselves be...

Background and Objectives: The aim of this study was to evaluate the prognosis after treatment for femoral neck fracture, to assess the impact of delay to surgery, and to devise a clinical prediction rule and score. Methods: A prospective observational study was conducted in which 1780 patients treated surgically in two teaching hospitals between 1 November 1997 and 31 October 1999 were followed over 12 months. Logistic regression was used to distinguish the effects of predictor variables on survival. Using a probit transformation of the predicted posterior probabilities of death, a prognostic score was devised with scores constrained so that a nominal score of approximately 90 represented a 50:50 chance of survival over 12 months. Results: Mortality was 30.1% in men and 19.5% in women. Increasing age, male gender, longer pre-operative delay, a higher American Society of Anesthesiology score, a lower Mental Test score, and a lower activities of daily living (Barthel) score were associated with increased risks of death. Of those waiting between 1 and 5 days for surgery, approximately 8 medium-risk and 17 high-risk patients (with prognostic scores of 90 and 120, respectively) would have to have their delay reduced to Ͻ24 hours to yield one additional survivor. Conclusion: The application of prediction rules must be guided by ethical, social, and scientific concerns.

Increases in the numbers of people participating in snow sports raise safety concerns. Despite declining numbers of skiing injuries among recreational skiers, collisions resulting in severe injuries appear to be on the rise. Skiers' risk of injury depends on a considerable number of different factors but only a few studies have investigated risk-taking behaviour and knowledge of proper skiing behaviour. To promote safe skiing the International Ski Federation (FIS) introduced regulations in 1967. We investigated participants' familiarity with the FIS regulations on the ski slopes in relation to age, skiing ability and country of origin. Random interviews were conducted with1450 recreational skiers at 17 ski resorts in Tyrol, an Austrian province. A questionnaire assessing skiers' knowledge of existing rules, their intuitive behaviour in given situations and perceptions of safety was developed. The study revealed that beginners, young skiers and those who were not local residents displayed insufficient knowledge. Risk-inducing situations that could result in collisions, such as moving upwards during carving, were largely assessed incorrectly. Appropriate intuitive behaviour increases with experience, and beginners are less able to implement FIS regulations than more experienced skiers. Ski resorts, the media and schools should direct educational efforts toward these high-risk groups. More research is needed to determine the causal connection between skiing injuries and disregard of the FIS Rules.

Despite 1.2 billion ambulatory visits in 2005, from a health care quality and safety perspective, the ambulatory setting has been less subject to research and scrutiny, compared to high-risk inpatient areas like surgery, perioperative and perinatal care, and the emergency department (ED). The ambulatory environment is prone to problems and errors that include missed/delayed diagnoses, delay of proper treatment or preventive services, medication errors/adverse drug events, and ineffective communication and information flow. Once there is clarity about the nature of outpatient errors, evidence-based teamwork tools, strategies, behaviors, and principles can be implemented as countermeasures to elements of the error chain. From the resources of the TeamSTEPPS™ initiative, six effective and evidence-based tools and strategies are offered for use by clinicians in the ambulatory setting to improve the quality and safety of patient care by improving teamwork and communication.

Purpose TrkB acts as an oncogenic kinase in a subset of human neuroblastomas. Lestaurtinib, a multi-kinase inhibitor with potent activity against Trk kinases, has demonstrated activity in preclinical models of neuroblastoma. Methods Patients with refractory high-risk neuroblastoma received lestaurtinib twice daily for 5 days out of seven in 28-day cycles, starting at 70% of the adult recommended Phase 2 dose. Lestaurtinib dose was escalated using a 3 ? 3 design. Pharmacokinetics and plasma phospho-TrkB inhibitory activity were evaluated in the first cycle. Results Forty-seven subjects were enrolled, and 10 dose levels explored starting at 25 mg/M 2 /dose BID. Forty-six subjects were evaluable for response, and 42 subjects were fully evaluable for determination of dose escalation.

Delirium is a common and serious problem for older hospitalized patients. This investigation proposes a multifactorial model of delirium etiology, involving a complex interrelationship of predisposing (vulnerability) factors and precipitating factors (acute insults). An overview of risk factors for delirium identified in 14 studies published since 1980 is provided. Although these studies identify key risk factors for delirium, they do not allow the examination of the interrelationship of predisposing and precipitating factors. Thus, we present two prospective cohort studies by our group which empirically examine: (1) predisposing (vulnerability) factors, (2) precipitating factors, and (3) the interrelationship of predisposing and precipitating factors. Understanding these risk factors is the key to developing appropriate preventive strategies and to target intermediate and high risk patients for intervention efforts.

Our hypotheses were (1) that plain radiography of the cervical spine in the evaluation of low risk patients with minor blunt trauma is accurate and (2) that computed tomography (CT) of the cervical spine in the evaluation of low risk patients is unnecessary. This study evaluates those hypotheses. We prospectively recorded findings of all patients with blunt trauma who underwent imaging over a period of 70 days. Injury status was determined by review of all radiographic studies obtained on each patient. Chart reviews were performed to determine mechanism of injury and neurological status. Patients were divided into three groups: very low risk, low risk, and high risk. Study end point was fracture. The study included 219 patients. The very low risk group had 107 patients, none of whom had fractures found on CT (projected specificity of plain radiography: 100%). The low risk group contained 78 patients who had no fractures seen on plain radiography or CT (specificity of plain radiography and CT: 100%). The high risk group consisted of 34 patients; 15 had fractures demonstrated on CT. Plain radiography missed one fracture out of 15. In low risk patients, plain radiography is an efficient diagnostic exam with a specificity of 100%. In high risk patients, plain radiography is a good adjunctive screening exam in conjunction with CT scan, with a sensitivity of 93.3% and specificity of 95%.

In the following study, the authors examine factors that explain citizen participation in crime prevention activities in Boston. Using survey data from a random sample, census data, and official crime and arrest data, the authors identified a wide range of individual- and community-based indicators that could potentially explain citizen involvement in crime prevention. Findings revealed that citizen involvement in collective

Depression in the elderly is nowadays a predominant health care problem, mainly due to the progressive aging of the population. It results from psychosocial stress, polypathology, as well as some biochemical changes which occur in the aged brain and can lead to cognitive impairments, increased symptoms from medical illness, higher utilization of health care services and increased rates of suicide and nonsuicide mortality. Therefore, it is very important to make an early diagnosis and a suitable pharmacological treatment, not only for resolving the acute episode, but also for preventing relapse and enhancing the quality of life. Age-related changes in pharmacokinetics and in pharmacodynamics have to be kept into account before prescribing an antidepressant therapy in an old patient. In this paper some of the most important and tolerated drugs in the elderly are reviewed. Tricyclic antidepressants have to be used carefully for their important side eects. Nortriptyline, amytriptiline, clomipramine and desipramine as well, seem to be the best tolerated tricyclics in old people. Second generation antidepressants are preferred for the elderly and those patients with heart disease as they have milder side eects and are less toxic in overdose and include the so called atypicals, such as selective serotonin reuptake inhibitors, serotonin noradrenalene reuptake inhibitors and noradrenaline reuptake inhibitors. Monoamine oxidase (MAO) inhibitors are useful drugs in resistant forms of depression in which the above mentioned drugs have no ecacy; the last generation drugs (reversible MAO inhibitors), such as meclobemide, seem to be very successful. Mood stabilizing drugs are widely used for preventing recurrences of depression and for preventing and treating bipolar illness. They include lithium, which is sometimes used especially to prevent recurrence of depression, even if its use is limited in old patients for its side eects, the anticonvulsants carbamazepine and valproic acid. Putative last generation mood stabilizing drugs include the dihydropyridine L-type calcium channel blockers and the anticonvulsants phenytoin, lamotrigine, gabapentin and topiramate, which have unique mechanisms of action and also merit further systematic study. Psychotherapy is often used as an adjunct to pharmacotherapy, while electroconvulsant therapy is used only in the elderly patients with severe depression, high risk of suicide or drug resistant forms.

The association between HIV infection and invasive cervical cancer that has been reported may reflect differential prevalence of human papillomavirus (HPV) infection or uncontrolled confounding. We conducted a case-control study in a West African population to assess the relationship between HIV infection and invasive cervical cancer, taking into account HPV infection and other potential risk factors for cervical cancer. Women with invasive cervical cancer (cases) or normal cervical cytology (controls) were recruited in a hospital-based case-control study in Abidjan, Côte d&#39;Ivoire. Odds ratios and 95% confidence intervals (CI) were estimated in logistic regression analyses controlling for important cofactors. HIV infection was noted in 22/132 (16.7%) cases and 10/120 (8.3%) controls (p = 0.048). High-risk HPV infection was detected in cervical tumor samples from 89.4% of case-participants and in cervical cytology samples in 31.1% of control-participants. In logistic regression a...

Objective There are more than 2,000 new cases of mouth cancer each year in Britain. Early detection is important yet little is known about population awareness of this disease and ability to recognise early signs, particularly among high risk groups. This study aimed to address this issue. Methods Data were collected by means of household survey. A total of 3,384 adults were questioned using a national probability sample. Respondents provided information on demographic characteristics, smoking status, and frequency of alcohol use. They were asked whether they had heard of mouth cancer. Their knowledge of early signs and risk factors was assessed. Results Whereas 95.6% of respondents said they had heard of mouth cancer, their awareness of early signs was low; for example, only 33.8% recognised that white patches in the mouth were a sign. The large majority understood that smoking and chewing tobacco were risk factors (84.7% and 80.1% respectively) but only 19.4% recognised alcohol use as a risk factor. In multiple logistic regression analyses controlling for relevant demographic factors, smokers and those with more frequent alcohol consumption were less likely to recognise early signs. Conclusions Awareness of early signs of mouth cancer is low and lower in people who as a result of their behaviour are at higher risk. There is a need to raise awareness in those at most risk.

Male college students constitute one of a number of at-risk populations susceptible to receiving and transferring sexually transmitted infections. Interventions designed to increase condom use have produced mixed results, but increasing motivation to use condoms may decrease risky sexual behavior. The current study examined the decisional balance, a component of Motivational Interviewing (MI), as an intervention to promote condom use. A total of 41 college men at-risk for negative outcomes from both unsafe sex and drinking participated. They reported both infrequent condom use and heavy drinking. Immediately following a decisional balance on condom use, three separate measures of motivation to change condom use increased. Further, participants reported increases in actual condom use at a 30-day follow-up. Participants did not alter their drinking behavior or their motivation to decrease problematic alcohol use. The findings provide preliminary support for the efficacy of a brief decisional balance intervention to increase safer-sex motivation and behaviors, but similar designs with true control groups receiving assessment only and larger numbers of participants are required before they can be generalized to the greater population of college students. College health professionals might adopt similar brief motivational enhancement interventions with the decisional balance to promote safer sex among at-risk college students.

This paper presents a conceptual framework that has Disease Control and Prevention now estimate that over guided three randomized, controlled early interven-300,000 individuals under 21 years of age in the United tion trials designed to improve cognitive development States are so poorly developed cognitively as to have and social competence in high-risk young children mental retardation (IQ Ͻ70) that could have been prefrom birth to 3 years of age. Two of the projects (Abecevented through early and continuing intervention. The darian and CARE) enrolled infants from economically full cost of this lack of prevention has yet to be deterand socially low-resource families and the other projmined. Epidemiological catchment area surveys reveal ect (IHDP) was an eight-site randomized controlled that risk for both mental retardation and poor school trial with 985 low birth-weight and premature infants readiness is highest among children from the lowest and their families. IHDP families varied widely in their socioeconomic status families (e.g., [12]). economic and social resources. Results consistently in-Remedial special education to improve cognitive dedicated positive effects of the intervention on child IQ velopment and academic achievement that is begun in during the first 3 years of life. Children from the lowest the elementary school years faces an enormous chalresource families consistently benefited the most from the early intervention. ᭧1998 American Health Foundation and Ac-lenge. In essence, the rate of cognitive development ademic Press must be altered if the progressive gap between normal Key Words: early intervention; mental retardation; at and subaverage cognitive development is to be arrested risk children; school readiness. and intellectual development is to be returned to normative trajectories. If genuine catch-up is to occur, then for a given period of intervention, the rate must actually

Self-efficacy may be associated with high risk behaviors in climbers operating at outdoor venues, though little is known about climbers recruited at indoor venues or less risky forms of rock climbing. Two-hundred and one active rock climbers (163 male) aged 16 to 62 years were recruited at five outdoor and six indoor climbing venues in Britain in a retrospective study. The relationship of self-efficacy to the frequency and difficulty of high and medium risk rock climbing behaviors was modelled using linear regression. Climbers high in self-efficacy engaged in both high and medium risk forms of rock climbing more frequently (β ≥ 0.18, 95% confidence interval [CI] 0.04 - 0.32) and at a higher level of difficulty (β ≥ 0.20, 95% CI 0.04 - 0.36). These associations were attenuated slightly with adjustment for covariates, though all remained significant. The same pattern of associations was observed for climbers recruited at indoor and outdoor venues, and for male and female climbers. Roc...

Because the particle number concentration in the area of the metal and alloys operation with the highest risk exceeded by at least two orders of magnitude the concentrations in other areas, particle number was considered as possibly a better metric (ref. B-2). Number concentration is strongly influenced by the smaller particle sizes. The mean particle size for the high risk

Bipolar disorder is relatively rare in obstetrics and gynecology (ob/gyn) practice compared with depressive and anxiety disorders, but there is a high risk for poor outcomes for patients and their offspring. Ob/Gyn physicians are assuming increasing responsibility for the care of these patients in today&#39;s managed care environment, working independently or in collaboration with a psychiatrist. The clinical presentation of bipolar patients may include mania and/or depression, in addition to more minor mood fluctuations that accompany the emotional and physical changes of pregnancy. The key issue in the differential diagnosis is to rule out medical, surgical, medication, and substance etiologies of mania that are potentially reversible. Indications for routine, urgent, and emergent referrals to a psychiatrist are reviewed. Treatment for bipolar women considering pregnancy includes prepregnancy planning education, involving the patient, family, psychiatrist, ob/gyn physician, and ma...