Alternative brain organization after prenatal cerebral injury: convergent fMRI and cognitive data.

The current study presents both longitudinal behavioral data and functional activation data documenting the effects of early focal brain injury on the development of spatial analytic processing in two children, one with prenatal left hemisphere (LH) injury and one with right hemisphere (RH) injury. A substantial body of evidence has shown that adults and children with early, lateralized brain injury show evidence of spatial analytic deficits. LH injury compromises the ability to encode the parts of a spatial pattern, while RH injury impairs pattern integration. The two children described in this report show patterns of deficit consistent with the site of their injury. In the current study, their longitudinal behavioral data spanning the age range from preschool to adolescence are presented in conjunction with data from a functional magnetic resonance imaging (fMRI) study of spatial processing. The activation results provide evidence that alternative profiles of neural organization can arise following early focal brain injury, and document where in the brain spatial functions are carried out when regions that normally mediate them are damaged. In addition, the coupling of the activation with the behavioral data allows us to go beyond the simple mapping of functional sites, to ask questions about how those sites may have come to mediate the spatial functions.     

Risk-Taking among Adolescents Who Say They Can Get a Handgun

In a survey of 5657 community-residing adolescents, those who said they could get a handgun in two days reported similar and those who said they could not get a handgun reported fewer risk behaviors and less violence perpetration and victimization than adolescents who have their own handgun. Adolescents who said they could get a handgun reported more exposure to and experience with firearms than those who said they could not get a handgun. Risk reduction efforts regarding adolescents should be expanded to include adolescents who say they can get a handgun.     

Assessing Performance and Expecting More: PART Assessments of Federally-Funded Addictions Treatment Programs

Effective programs set ambitious goals, achieve results, are managed well, and improve efficiency. Assessing performance, managing results, and assuring effective use of tax dollars is challenging and complex. This column describes how the federal government uses the Performance Assessment Rating Tool (PART) to ensure that its programs perform well and use public resources responsibly, and includes summaries of the performance assessments of three federally funded addiction treatment programs. An understanding of this process may help local addiction treatment programs implement similar strategies to improve their own performance, and thus contribute in a more meaningful way to improved outcomes for populations being treated for addictive disorders.     

An Atypical Recurrence of Endometrial Carcinoma Following Estrogen Replacement Therapy

Following an abdominal hysterectomy and bilateral salpingoophorectomy wherein a superficial (1.6 mm) well-differentiated endometrial cancer and bilateral ovarian serous cystadenomas were discovered, estrogen replacement was given. One year later the patient presented with a 9 × 7-cm left groin recurrence. Patients with endometrial carcinoma may request estrogen replacement. The benefits of such replacement are well recognized; however, these patients also need to be counselled that hormonal replacement may be complicated by recurrence. Physicians need to be cognizant of symptoms or signs which would suggest disease recurrence at unusual sites in these patients who are perceived as being at low risk for recurrent disease.     

Teaching Culturally Appropriate Care: A Review of Educational Models and Methods

The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient.     

Poverty and health in West Germany

Summary The relationship between poverty and several health-related characteristics in West Germany was investigated. Data were derived from the National and Regional Health Surveys conducted in West Germany from 1984 to 1992. 25544 males and 25719 females with German nationality aged 25–69 years were examined. Poverty was defined as a household income of 50% less than the mean for West Germany. Multiple logistic regression analysis was used to analyze the relationship between poverty and four health variables: individual health behavior, subjective assessment of health status, cardiovascular disease risk factors, and self-reported prevalence of lifetime chronic diseases. 10.2% of males and 12.8% of females were classified as being below the poverty line. For most but not all health parameters, less favourable results were found for the segment of the population with a household income below the poverty line. The most striking poverty-related differences were observed for lack of regular sport activities, subjective health satisfaction, obesity and myocardial infarction/stroke. Significantly lower prevalence rates for study subjects below the poverty line were observed for hypercholesterolemia in females only. Allergic disorders were the only chronic diseases reported significantly less often in males and females below the poverty line. Poverty has strong effects on individual health status and the prevalence of chronic diseases. Due to the rising unemployment rates in Germany in the last years it is very likely that the strong negative consequences of poverty for health are increasing.

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Zusammenfassung Es wird untersucht, welche Zusammenhänge zwischen Armut und verschiedenen gesundheitsbezogenen Merkmalen bestehen. Datenbasis sind die nationalen und regionalen Gesundheitssurveys, die in den Jahren 1984 bis 1992 in Westdeutschland durchgeführt wurden. 25544 Männer und 25719 Frauen mit deutscher Nationalität im Alter von 25 bis 69 Jahren wurden einbezogen. Armut wurde definiert als ein Haushaltseinkommen, das um 50% niedriger ist als das mittlere Einkommen in Westdeutschland. Die statistische Auswertung erfolgte mittels multipler logischer Regressionsanalyse, 10,2% der Männer und 12,8% der Frauen hatten ein Haushaltseinkommen unterhalb der Armutsgrenze. Die ausgeprägtesten armutsbezogenen Unterschiede wurden beobachtet für den Mangel an körperlicher Bewegung, die subjektive Gesundheitszufriedenheit, das starke. Übergewicht und die kardiovaskulären Krankheiten. Signifikant niedrigere Prävalenzen für Personen mit Einkommen unterhalb der Armutsgrenze ergaben sich bei den Frauen für den Risikofaktor Hypercholesterinämie. Allergien waren die einzige chronische Krankheit, die bei beiden Geschlechtern signifikant seltener in der von Armut betroffenen Bevölkerungsgruppe berichtet wurde. Vor dem Hintergrund der in den letzten Jahren stark angestiegenen Arbeitslosigkeit in Deutschland ist zu befürchten, dass die negativen Konsequenzen der Armut für die gesundheitliche Lage deutlich zugenommen haben.

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Résumé Les rapports entre pauvreté et differents indices sanitaires ont été examinés. Les donnees proviennent des surveys de santé nationales et régionales, réalisées en Allemagne de l'Ouest durant les années 1984 à 1992. 25719 femmes et 25544 hommes de nationalité allemande entre 25 et 69 ans ont paticipé. Le seuil de pauvreté a été fixé à un revenu égal a 50% du revenu moyen en Allemagne de l'Ouest. On a analysé les indices sanitaires suivants: le comportement sanitaire individuell, l'auto-estimation de sa santé, les facteurs de risque cardio-vasculaires et la prévalence des maladies chroniques. L'analyse statistique a été réalisée par regression logique multiple. 12,8% des femmes et 10,2% des hommes avaient un revenu inferieur au seuil de pauvreté. Pour la majorité des indices sanitaires on a trouvé des résultats défavorables pour la groupe ayant un revenu au dessous du seuil de pauvreté. Le manque de mouvement, l'auto-estimation de sa santé, l'excés de poids et les maladies cardio-vasculaires sont les indices quid diffèrent, relatif à la pauvreté, le plus. Les femmes ayant un revenu au-dessous du seuil de pauvreté ont des pourcentages de prévalence inférieurs significatifs pour le facteur de risque hypercholestérolémie. Les allergies sont les seules maladies qui existent significativement moins souvent chez les deux sexes de la groupe des pauvres. En résumé, la pauvreté présente un désavantage pour la santé individuelle et la prévalence des maladies chroniques. Sachant que le taux de chômage s'est aggravé pendant les dernières années, il est à craindre que les effets négatifs de la pauvreté sur la situation sanitaire ont nettement augmenté.

     

Newspaper coverage of residential fires: an opportunity for prevention communication.

BACKGROUND: Worldwide, fire-related burns are a major cause of unintentional injury, morbidity and mortality, with the majority of deaths occurring in developing countries. In the US, as in other countries, most fatal fires occur in the home. Effective prevention strategies for residential fires are, however, currently underutilized. The news media is one available communication channel to promote such strategies, and analyzing current news coverage is a first step towards incorporating media advocacy into injury prevention efforts related to residential fires. METHODS: Four daily newspapers circulating widely in Maryland were monitored for 1 year. Articles describing residential fires were coded for measures of prominence, content and frame. Analysis focused on measures of issue newsworthiness, reporting of causation and consequences of fires, and inclusion of public health context and conveyance of prevention messages. RESULTS: The data indicate that fires are newsworthy, with 374 relevant news articles in a 1-year period, 32% of which appear on the first page of a section. Coverage generally concerned recent local fire events. Most articles discussed the consequences of fires (88%), and identified a causal factor (58%). Only 36%, however, included prevention information, and less than one-quarter set residential fires in a public health context. CONCLUSION: The newsworthiness of residential fires provides a clear opportunity for widespread communication around injury prevention. Improving media advocacy will entail framing discussion of recent fire events in such a way as to support inclusion of prevention strategies and a public health context in news coverage.