[Fatal toxic leukoencephalopathy associated with consumption of pasta base of cocaine: Report of three cases]. / Leucoencefalopatía tóxica fatal: tres casos asociados al consumo de pasta base de cocaína.

The prevalence of drug-associated toxic encephalopathy is unknown, but it is an uncommon condition. Toxic leukoencephalopathy was described associated with heroin consumption, it has been less commonly described with the use of cocaine and there are no reports of its association with consumption pasta base of cocaine (PBC). We report two females aged 31 years and a male aged 19 years, consumers of PBC who developed a fatal toxic leukoencephalopathy. They initiated their disease with severe and persistent headache, sequential focal neurologic deficits and a progressive impairment of consciousness that culminated with their death. Laboratory parameters such as blood count, cerebrospinal fluid analyses or infectious biological indices were normal. MRI showed multifocal lesions in brain white matter of both hemispheres confirming the leukoencephalopathy. There was no response to the use of methylprednisolone.

Enamel defects in the deciduous dentition as a potential predictor of defects in the permanent dentition of 8- and 9-year-old children in fluoridated Cheshire, England.

It is claimed that dental fluorosis in both deciduous and permanent teeth is increasing in fluoridated and non-fluoridated communities. What is unclear is whether fluoride-induced enamel opacities in the deciduous dentition are associated with the subsequent appearance of enamel defects in the permanent dentition. The aim of this study was to establish whether a relationship existed between the presence of diffuse enamel defects on the deciduous molars and permanent incisors of schoolchildren who were lifetime residents in an optimally fluoridated community in Cheshire, England. The dentitions of eight-and nine-year-old children were examined by two examiners, each unaware of the findings of the other. There was a significant increased risk of diffuse enamel defects in the permanent incisors for those children who presented with diffuse defects on their first deciduous molars (Relative Risk, 1.45; 95% confidence interval, 1.05 to 2.0) or second deciduous molars (Relative Risk, 1.86; 95% confidence interval, 1.36 to 2.54). In light of these findings, it is worth considering the potential of the presence of enamel defects in deciduous molars in children aged 1 to 3 years as a predictor of the future appearance of similar lesions in their permanent incisors.

Living with an amputation: the helper.

One hundred and nine key helpers were interviewed in connection with a study of the psychosocial implications of amputation. They were found to carry formidable burdens. Social isolation was a major problem which increased over time and was associated with diminished capacity to express needs. The respondents discussed emotional problems readily. Social workers had little sustained contact with helpers: welfare agencies had intervened mainly to provide practical help. The Artificial Limb Centre did not routinely see helpers or communicate with General Practitioners. A more realistic approach to the support of those who implement community care policies is advocated, with particular reference to the need for respite care to be provided in the domestic setting. The dangers of the exploitation of women as carers are highlighted.

Reasons for non-attendance for computer-managed cervical screening: pilot interviews.

A pilot interview study looked at reasons why women did not attend a clinic following an invitation for a cervical smear test offered via a computer-managed scheme. Three broad issues were identified. First, the inaccuracy of the computer database (the FPC register) meant some women were inaccessible because they no longer lived at the address recorded. Other women were ineligible or unsuitable within the criteria of the scheme but had been sent invitations inappropriately because their screening records were incomplete or out of date. Second, aspects of service organisation and provision led to misclassification of some attenders as non-attenders and to various failures of communication such as non-receipt of the invitation or health education leaflet or unsuccessful attempts to rearrange appointments. In addition, the appointment or venue offered could be unsatisfactory. The third issue concerned the characteristics of the women which sometimes interacted with practical problems connected with service provision. Other women believed the test to be inappropriate for themselves while some were deterred by the prospect of the test itself. In general, embarrassment was pervasive and reflected in preferences for different types of service provision. Women who had neither attended nor been otherwise tested were particularly likely to express feelings of fear and fatalism. General attitudes to the test were favourable but this was not always applied personally. A typology of reasons for non-attendance for computer-managed cervical screening is presented.

Attendance for cervical screening--whose problem?

Despite the existence of an effective screening technique for cancer of the cervix, incidence and mortality from this disease have not declined in the United Kingdom. The basic problem is that women most at risk of the disease are under-represented in the screened population. The evidence for two different points of view to explain this situation is examined. These viewpoints are the failure of the women to attend, and the failure of the service to meet the needs of women. This paper argues that the evidence supports the view that the organisation of the existing screening service impedes the maximum participation of at-risk women. We discuss the features that an effective service needs to incorporate, and put forward principles for the development of a more effective screening system, namely, that it should be provider-initiated and user-oriented.

Hypothesis: common bacterial toxins are a possible cause of the sudden infant death syndrome.

It is hypothesised that common toxins produced by bacteria growing in the respiratory tract following a viral infection are a cause of SIDS. This hypothesis is consistent with evidence that viral infections pre-dispose to SIDS, minimal morphological change at autopsy, maximum incidence during sleep and the age incidence of this disease. We present evidence of nasopharyngeal bacterial overgrowth in victims of SIDS and have developed a mathematical model based on the hypothesis which closely predicts the age distribution. The model predicts other age distribution patterns for less common toxins and these may apply to other diseases of childhood. The hypothesis can be tested and if sustained would offer hope of prevention.

Living with an amputation: what it means for patients and their helpers.

The social and emotional problems declared by 134 single-leg amputees are compared with those of 109 people who were their main helpers. The Day Amputee Activity Score, the Goldberg GHQ, Townsend's Social Isolation scale and Forder's concept of Felt Need were used in the study. The majority of patients were elderly males. Most of the carers were women. Peripheral vascular disease was the most frequent reason for the amputation and its persistence postoperatively was predictive of poor rehabilitation outcome. The respondents reported unmet need for information about financial help, employment and social activity. Both groups shared a high level of social isolation, which was associated with risk of psychiatric illness and appeared to inhibit the expression of need. Helpers complained more forcefully than patients about service provision and discussed their emotional reactions more readily. The amputees tended to use denial in confronting the implications of limb ablation. Many respondents had no sources of help with personal or practical problems. Their knowledge of available services was poor. In particular, the role of social workers was not well understood. Neither the social work profession nor the Artificial Limb Centre was used to any appreciable extent as a source of help with psychosocial adjustment to loss of a limb.

Health education in a computer-managed cervical screening programme.

In designing health education material for a cervical screening programme, attention needs to be given to those features identified by research as influencing women's use of screening services. These include not only women's attitudes and beliefs about cervical screening, but also organisational and administrative barriers that can deter women from attending for a smear test. Health information may be presented through a variety of media and at different stages in the cervical screening decision-making process. This paper describes the specific health education used in a computer-managed scheme and how it was modified in the light of findings from research which monitored and evaluated the scheme.

Trends in the organization of cervical cancer screening.

Cervical cytological screening has been available in the UK for several decades, but has not achieved a significant reduction in the incidence of and mortality from cervical cancer. In this paper we describe past problems of cervical screening, discuss the impact of recent innovations to computerize call and recall, and suggest further improvements for the future.

Leucoencefalopatía tóxica fatal: tres casos asociados al consumo de pasta base de cocaína / Fatal toxic leukoencephalopathy associated with consumption of pasta base of cocaine: Report of three cases

The prevalence of drug-associated toxic encephalopathy is unknown, but it is an uncommon condition. Toxic leukoencephalopathy was described associated with heroin consumption, it has been less commonly described with the use of cocaine and there are no reports of its association with consumption pasta base of cocaine (PBC). We report two females aged 31 years and a male aged 19 years, consumers of PBC who developed a fatal toxic leukoencephalopathy. They initiated their disease with severe and persistent headache, sequential focal neurologic deficits and a progressive impairment of consciousness that culminated with their death. Laboratory parameters such as blood count, cerebrospinal fluid analyses or infectious biological indices were normal. MRI showed multifocal lesions in brain white matter of both hemispheres confirming the leukoencephalopathy. There was no response to the use of methylprednisolone.

Living with an amputation: the patient.

The findings of a study of 134 single-leg amputees are presented, comparing those who had recently lost a leg with others who had worn prostheses for 1-2 years. Social isolation, psychological risk and felt need were the principal indicators of level of adjustment selected. On none of these measures did experienced prosthesis-wearers show any appreciable improvement over amputees in the early stages of prosthetic rehabilitation. Severe social isolation was present in both groups, and seemed to inhibit the declaration of needs. The persistence of peripheral vascular disease was predictive of poor rehabilitation outcome.

Community screening for mental illness: a validity study of the General Health Questionnaire.

The 60-item GHQ was validated in a community population by comparison with the CIS. The GHQ failed to identify nearly half of the psychiatric 'cases' in this population. Those missed were similar to those detected except for greater chronicity of illness and more frequent social and interpersonal problems. The GHQ appears to be unsuitable as a screening instrument for mental illness in the community and the possible reasons are discussed. Principal components and analysis resulted in a 15-item GHQ factor which, when used with Likert scoring, resulted in considerable improvement and failed to identify only 4 per cent of 'cases'. It is suggested that this may prove a more satisfactory screening instrument.

Determinants of users' satisfaction with primary health care settings and services in Saudi Arabia.

OBJECTIVE: To identify the components of primary health care that cause most concern to service users and to identify socio-demographic and other factors associated with satisfaction among the users of primary health care centres. DESIGN: Interviews conducted by well-trained interviewers with a random sample of heads of households. The questionnaires were composed of questions that measure the extent of satisfaction with settings and services in the primary health care centres using a 5-point rating scale from very satisfied to very dissatisfied. SETTING: The community of Qateef, eastern Saudi Arabia. STUDY PARTICIPANTS: A sample of 802 households representing 838 families was chosen randomly from the housing lists of the primary health care centres in Qateef. There were 40 vacant houses and nine refusals. Thus the number of heads of households actually interviewed was 789. RESULTS: Waiting area structure, confidentiality measures and environmental structure were the areas that caused most concern to service users. The factors that showed the greatest association with satisfaction were the type of the primary health care centre building (purpose-built or rented), literacy status of the household head (literate or illiterate), the extent of the primary health care centre utilization (regular or infrequent). Surprisingly, age showed no association when other characteristics of the respondents were adjusted for, and sex was less important than in other studies. CONCLUSION: How regular the respondent was in using his or her primary health care centre was more predictive in deciding the extent of satisfaction with the various components in the study than the other variables. Socio-demographic factors played minor roles in deciding the extent of satisfaction, although each had a deciding role with one or more, but not all, components.

Well you can come in but i'm not having it. The role of the health visitor in computer-managed cervical screening.

Health visitors called on women who had not attended for a cervical smear test, following an invitation via a computer-managed scheme. Reasons for non-attendance were identified and the study showed that health visitors can be successful in encouraging some non-attenders to be screened. However, there are problems involved in undertaking such a role, which must be acknowledged if the health visitors's time is to be used effectively.

Breast self-examination: how committed are women? How committed are we?

Breast self-examination (BSE), increasingly promoted as a good health habit, is gaining recognition by surgeons as a significant factor in tumour size and staging at diagnosis. Clinically-based reports leave unanswered important behavioural questions and pay scant attention to the quality of the teaching or of the practice of BSE. This paper argues that if BSE is to be used as the coarse-screening modality of which it seems to be capable, we must apply to it the same criteria as to other screening modalities. Since BSE ipso facto must be undertaken by the women herself, it is a screening in which subject behaviour is crucial. Promotion of BSE requires not only behaviour change but also maintenance and support. Behavioural aspects are discussed in relation to a recent major study of the teaching and practice of BSE.

Breast screening by breast self-examination: an evaluation of teaching methods and materials.

A base-line survey of women's opinions on breast cancer and breast self-examination (BSE) suggested a link between high awareness of BSE and a view of breast cancer as the most worrying illness they could suffer. Data from pre-teaching questionnaires compares awareness of and performance of BSE with six opinions related to the vulnerability of women to breast cancer and to possible outcomes. Inferences from statistically significant associations, which also replicated survey findings, led to the development of three alternative models of teaching methods. The findings also suggest that "concern" is a more accurate term than "anxiety" in describing perceptions of vulnerability and of BSE.

Association between perceived health status and satisfaction with quality of care: evidence from users of primary health care in Oman.

OBJECTIVE: Our aim was to assess the influence of perceived health status, as measured by SF-12, on the client's views of service quality. METHODS: A structured interview of patients was carried out in six primary health care centres in Adh Dhahira region health authority in the Sultanate of Oman. A total of 1226 patients aged 15 and over attending the different health care services within the health centres took part in the study. The main outcome measures were patients' satisfaction with the different aspects of health care and their perceived physical and mental health status. RESULTS: When adjusted for the relevant background factors such as age and gender, poor perceived health status has been found to predict less positive judgements of various aspects of health care quality. Poor mental health status, for example, predicts less positive judgements of aspects that are linked to the accessibility of the service and interpersonal aspects of care such as the working hours of the centre, GP's attitude and time spent with the GP (P < 0.05, <0.05 and <0.01, respectively). Poor physical health status, on the other hand, predicts less positive judgements of aspects such as cleanliness of the building, confidentiality of consultation with the GP, explanation about the visit to the antenatal clinic and standard of antenatal clinic in general (P < 0.05, <0.05, <0.05 and <0.05, respectively). CONCLUSION: Users' perceived health status has to be evaluated concurrently with assessing satisfaction with the quality of health care services. This would provide more valid results with regard to the patients' views on their level of satisfaction with health care quality.

Cervical screening: what are the communication problems?

Computer-managed call and recall schemes offer the opportunity for effective cervical screening. However, such schemes involve several different agencies, often independent of one another. As a result, problems of communication can arise. This paper discusses potential areas of difficulty and presents some suggestions for improvement.