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991.
Samuel R. Friedman Barbara Tempalski Hannah Cooper Theresa Perlis Marie Keem Risa Friedman Peter L. Flom 《Journal of urban health》2004,81(3):377-400
This article estimates the population prevalence of current injection drug users (IDUs) in 96 large US metropolitan areas
to facilitate structural analyses of its predictors and sequelae and assesses the extent to which drug abuse treatment and
human immunodeficiency virus (HIV) counseling and testing are made available to drug injectors in each metropolitan area.
We estimated the total number of current IDUs in the United States and then allocated the large metropolitan area total among
large metropolitan areas using four different multiplier methods. Mean values were used as best estimates, and their validity
and limitations were assessed. Prevalence of drug injectors per 10,000 population varied from 19 to 173 (median 60; interquartile
range 42–87). Proportions of drug injectors in treatment varied from 1.0% to 39.3% (median 8.6%); and the ratio of HIV counseling
and testing events to the estimated number of IDUs varied from 0.013 to 0.285 (median 0.082). Despite limitations in the accuracy
of these estimates, they can be used for structural analyses of the correlates and predictors of the population density of
drug injectors in metropolitan areas and for assessing the extent of service delivery to drug injectors. Although service
provision levels varied considerably, few if any metropolitan areas seemed to be providing adequate levels of services. 相似文献
992.
Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. The legal frameworks relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa. 相似文献
993.
994.
Herman Nys Sander Welie Tina Garanis-Papadatos Dimitris Ploumpidis 《Health care analysis》2004,12(4):329-337
The discriminatory effects of categorizing psychiatric patients into competent and incompetent, have urged lawyers, philosophers and health care professionals to seek a functional approach to capacity assessment. Dutch and English law have produced some guidelines concerning this issue. So far, most legal systems under investigation have concentrated on alternatives for informed consent by the patient in case of mental incapacity, notably substitute decision-making, intervention of a judge and advance directives. It is hard to judge the way in which the law may further adapt to a more functional assessment of capacity, because the nature of law shows that legal reforms usually take place only when new methods have been accepted by the field. This is not yet the case today. 相似文献
995.
996.
997.
Claudio De Felice Mitchell R Goldstein Stefano Parrini Alberto Verrotti Mario Criscuolo Giuseppe Latini 《Pediatric critical care medicine》2006,7(2):138-142
OBJECTIVE: No reliable clinical markers of histologic chorioamnionitis (HCA), a major and often subclinical cause of prematurity leading to high neonatal morbidity and mortality, are available to date. Increasing evidence indicates myocardial dysfunctions in affected fetuses and newborns. We sought to assess the value of nonlinear dynamics from pulse oximetry signals in identifying affected newborns. DESIGN: Prospective case-control study. SETTING: Tertiary level neonatal intensive care unit, Brindisi Hospital. PATIENTS AND INTERVENTION: Pulse oximetry-derived signals (pulse rate, oxygen saturation, and perfusion index), recorded within the first 1.5 hrs of life, were analyzed for 110 very low-birth-weight infants, of whom 54 had histopathological evidence of HCA. MEASUREMENTS AND MAIN RESULTS: Four different time series parameters were determined for nonlinear dynamical (NLD) analysis. Significantly decreased Lempel-Ziv, Lyapunov largest exponent, and correlation dimension, with significantly increased Hurst values for heart rate and perfusion index (p < .00001), were observed in newborns with HCA. Heart rate Lempel-Ziv =0.218 showed 100% sensitivity (95% confidence interval, 98.8-100) and 100% specificity (95% confidence interval, 98.6-100) in distinguishing cases from controls, with positive and negative predictive values of 100% and 95.7%, respectively. CONCLUSIONS: Our findings indicate that early autonomic tone balance abnormalities are present in newborns with HCA and suggest that early dynamic analysis of pulse oximetry signals could be useful in identifying affected infants. 相似文献
998.
Stefano Luisi Massimo Gabbanini Sofia Sollazzi Francesco Calonaci Sandro Razzi Felice Petraglia 《Gynecological endocrinology》2006,22(5):284-285
BACKGROUND: Cutaneous endometriosis is a rare condition. CASE REPORT: A 37-year-old woman came to our observation 3 years after Cesarean section for a nodule under the scar that became spontaneously painful during menstrual bleeding. Transabdominal ultrasound examination, serum CA125 determination and histopathological analysis of the nodule were performed. Ultrasound revealed the presence of an oval-shaped hypoechogenic neoformation, while the serum CA125 level was slightly increased, and a diagnosis of endometriosis was confirmed by the histopathological analysis of a surgical specimen. CONCLUSION: This is an interesting case of surgical scar endometriosis, and the etiopathogenetic mechanism of this location may be explained by a dissemination of endometrial tissue during the Cesarean section. 相似文献
999.
1000.
Stefano Pini Valéria de Queiroz Daniel Pagnin Lukas Pezawas Jules Angst Giovanni B Cassano Hans-Ulrich Wittchen 《European neuropsychopharmacology》2005,15(4):425-434
A literature search, supplemented by an expert survey and selected reanalyses of existing data from epidemiological studies was performed to determine the prevalence and associated burden of bipolar I and II disorder in EU countries. Only studies using established diagnostic instruments based on DSM-III-R or DSM-IV, or ICD-10 criteria were considered. Fourteen studies from a total of 10 countries were identified. The majority of studies reported 12-month estimates of approximately 1% (range 0.5-1.1%), with little evidence of a gender difference. The cumulative lifetime incidence (two prospective-longitudinal studies) is slightly higher (1.5-2%); and when the wider range of bipolar spectrum disorders is considered estimates increased to approximately 6%. Few studies have reported separate estimates for bipolar I and II disorders. Age of first onset of bipolar disorder is most frequently reported in late adolescence and early adulthood. A high degree of concurrent and sequential comorbidity with other mental disorders and physical illnesses is common. Most studies suggest equally high or even higher levels of impairments and disabilities of bipolar disorders as compared to major depression and schizophrenia. Few data are available on treatment and health care utilization. 相似文献