The contribution of late termination of pregnancy to stillbirth rates in Northern England, 1994-2005.

The impact of late terminations (> or = 24 weeks) on the overall stillbirth rate was determined for the 12-year period from 1994 to 2005 using data collected by the Regional Maternity Survey Office in the north of England. It is a legal requirement to register late terminations, and this may lead to an overestimation of the true stillbirth rate. In our region, terminations resulting in stillbirth increased the registered stillbirth rate by nearly 10%. The impact remained stable for the period 1998-2005. This suggests that the failure of the national (and regional) stillbirth rate to decline in recent years is not due to an increase in late terminations.

Infrared study of orientational order parameters of a ferroelectric liquid crystal.

A method of determining the set of four order parameters S , D , P , and C for a ferroelectric liquid crystal, using complementary results for different sample geometries, is presented. IR measurements have been performed for homeotropic, planar heterogeneous and, planar homogenous sample geometries. Orientational order parameters were determined in two frames of reference to obtain complete information on molecular arrangement. Results for the D , P , and C parameters indicate the importance of both the intrinsic and extrinsic biaxialities. The molecular rotation around the long molecular axis is not free, and the carbonyl dipole and plane of the central phenyl ring are oriented close to the tilt plane. It has been found that transition dipole moments show significant correlations, antiparallel for longitudinal dipoles and parallel for transversal ones.

Medical investigations requested by patients: how do primary care physicians react?

BACKGROUND AND OBJECTIVES: We investigated the characteristics of patients who request medical investigations and the type of tests requested to study the manner in which primary care physicians react to these requests. METHODS: The study was conducted within the framework of a national health insurance system. Twelve primary care practices from three randomly chosen clinics with different population characteristics participated in the study. The attending physicians were instructed to ask all patients who presented to the clinics within a 7-month period and requested a medical test to complete a questionnaire, indicating the type of test(s) requested and the reason. The physicians were asked to rate the manner in which the patient made the request, their own reaction to the request, and whether they ordered the tests that were requested. RESULTS: During the survey period, 12,322 patients visited the clinics, of whom 295 (2.4%) were reported by a physician to have requested a medical investigation. More-educated patients were more likely to request tests for disease prevention. The types of tests requested were imaging scans, laboratory (blood) tests, and others. The main reason for the request was symptoms (60%), followed by disease prevention (25%). More than 30% of the requests generated self-reported negative feelings in the physician. Physician compliance with patient requests was not significantly correlated with the reason for the request. Laboratory tests were ordered significantly more often than other types. There was a strong correlation between physicians' compliance with the request and physicians' feelings about the request. CONCLUSION: Our findings raise questions about the frequency with which physicians order tests solely in response to patients' requests and provide information about circumstances in which patients make requests for medical investigations.

Israel under threat of biological warfare--the reactions of our patients during the 1998 Persian Gulf crisis.

BACKGROUND AND OBJECTIVES: During February 1998, there was heightened tension in the Persian Gulf area. Iraq's ruler, Saddam Hussein, threatened Israeli citizens with the use of biological weapons. This study observed the use of health care services by patients visiting our clinics during this period. METHODS: During the period of February 17, 1998, through March 1, 1998, 12 family physicians classified all clinic visits as "related" or "unrelated" to the crisis. The participating clinics were situated in (A) high-risk and (B) low-risk areas, according to their location as related to missile hits during the 1991 Gulf War. RESULTS: A total of 1,841 visits were recorded during the crisis period (February 17-23). There were 934 visits in Area A and 907 in Area B. Overall, 194 visits related to the crisis were recorded, of which 155 were in Area A. The rate of crisis-related visits was higher in Area A (16.6% versus 3.4%). There were more visits for authorizations for special masks (8.2% versus .8%), requests for information (3.9% versus 1.3%), and tranquilizers (2.1% versus .5%). In the period subsequent to the agreement reached on February 24, crisis-related visits declined sharply in both areas. CONCLUSIONS: During the crisis, there was an increase in visits related to the threat of biological warfare. The phenomenon was more pronounced in areas that had sustained missile hits during the 1991 Gulf War.

Patients' attitudes towards the presence of medical students in family practice consultations.

BACKGROUND: Patients' consent to being part of medical education is often taken for granted, both in primary and secondary care. Formal consent procedures are not used routinely during teaching and patients are not always aware of teaching activities. OBJECTIVE: To investigate patients' attitudes and expectations on issues of consent regarding participation in teaching in general practice, and the influence of a student's presence on the consultation. METHODS: The study took place in 46 teaching practices during the sixth year clinical internship in family medicine. Patients completed questionnaires at the end of 10 consecutive eligible consultations. The questionnaire contained data on the willingness to participate in teaching, the preferred consent procedure and the effects of the student's presence. The doctors were asked to estimate the sociodemographic level in their clinic area. RESULTS: A total of 375 questionnaires were returned; the response rate was not affected by the clinic's sociodemographic level. Overall, 67% of the patients had come into contact with students in the past; 3.2% of the participants objected to the presence of a student during the consultation; 15% would insist on advance notification of the presence of a student, and another 13.9% would request it; 4% stated that the presence of students had a detrimental influence on the physical examination and history; and 33.6% would refuse to be examined by a student without the doctor's presence. CONCLUSION: Most patients agreed to have a student present during the consultation; some would like prior notification; a minority refused the student's presence. A large minority would refuse to be examined without the tutor's presence. Our findings need to be taken into account when planning clinical clerkships.

[Physical activity habits of primary care clinic patients].

764 registered clinic patients, between the ages of 18-60, in 2 primary-care clinics, filled out questionnaires about exercise habits. One clinic is in a moshav in which the population is principally of European origin and of high socioeconomic status. The other clinic is in a town in which the population is mainly of North African or Asian origin and of low socioeconomic status. Only 38.6% of those studied defined their work as involving physical or marked physical activity. These tended to be males 18-30 years old living on the moshav. Only 14.2% reported regular sports activity, none of whom were from the town. No differences were noted in sex or age-distribution. Women tended to engage in gymnastics, walking or folk-dancing; men in running or ball sports. Our results are similar to those of other studies which show that Israelis do not tend to engage regularly in sports. It is emphasized that health organizations should encourage sport activity by their members.

[Smoking behavior of primary-care clinic patients].

Smoking habits in 1027 patients over the age of 18 in our 2 primary care clinics were surveyed by means of questionnaires which were filled out by 92% of the total population surveyed. 31% of the men and 20% of the women smoked, while 22.9% and 9.5%, respectively, were ex-smokers. The proportion of smokers decreased with increasing age. There was a greater proportion of smokers and of heavy smokers in the Tel Mond clinic in which the patients were of Afro-Asian origin and of lower socio-economic status. In the Herut clinic, in which the patients were of European origin and higher socio-economic status, there were fewer smokers and they had started smoking at an older age. 41% of all smokers expressed a desire to stop smoking. 60.7% of those who had stopped smoking had done so because of some illness or symptom. Very few said they had stopped because of medical advice (1.8%) or anti-smoking propaganda in the media (0.6%). Despite the general reduction in smoking since previous studies, there is need for much more intervention by family physicians.

[Use of diuretics in family practice].

Of 1894 patients registered in a family medicine clinic, 101 (5.3%) had been taking diuretics for at least 6 months. The sex distribution was equal and the average age was 68.7 years. 60% were taking Kaluril, 30% Aquadon and 10% Frusemide. Most had hypertension or heart failure, or both. 6 patients developed hyperglycemia, 2 hyponatremia, 5 hypokalemia, 2 hyperkalemia and 10 hyperuricemia. In 19 the ECG showed arrhythmias. 5 of 56 patients had hypomagnesemia and another 12 had low borderline levels. In the light of these results and those in the literature, we conclude that diuretics are not as safe as previously thought.

[The influence of the presence of students on the consultation--attitudes of tutors in family medicine clinics].

BACKGROUND: The consultation is the pivot of clinical teaching in ambulatory care. It is therefore essential that students observe the consultation. The students' presence itself influences the consultation and also requires the patients' consent. Moreover the introduction in Israel of the "Patients' Rights Act" in 1996 has made us more acutely aware of the place of the patient in teaching especially with regard to the consent to be part of the teaching process. AIM: This study was undertaken in order to investigate how tutors in family medicine perceive changes in the consultation caused by the presence of students. METHODS: An anonymous physician questionnaire was distributed on the first day of the 6th year clinical clerkship in family medicine. The questions pertained to perceived influence on length and content of the consultation. In addition physician and patient background information was gathered; and the physicians were asked to estimate the patients' willingness to be part of the teaching process. RESULTS: 46 tutors in family medicine participated, 70% of whom were female. Sixty four percent of the doctors thought that the student's presence had an influence on the consultation. Ninety one percent thought that it increased consultation length, especially of the physical part (93%). More than half thought that the student's presence might interfere with asking intimate questions. The majority held the opinion that the patient's gender and socioeconomic background were inconsequential. Ninety two percent of physicians estimated that 5% or less of the patients would refuse the presence of a student. IN CONCLUSION: Tutors in family medicine think that the presence of a student affects the consultation. Those involved in and responsible for teaching should take this into account. Further research of these changes with objective measurements is needed.

[Influence of cryotherapy in the inhibition of collagenase activity in experimental corneal burns by hydrochloric acid. Doctoral thesis summary]. / Wplyw krioterapii na hamowanie aktywnosci kolagenolitycznej w doswiadczalnych oparzeniach rogówki kwasem solnym. Streszczenie pracy doktorskiej.

Investigations were carried-out on corneas of rabbit eyes burned with 1N HCl and then treated with low temperature. It was found that cryotherapy has advantageous influence on collagenase activity. In early period after burn cryotherapy could prevent collagenolysis and later inhibited collagenase activity.

[The use of "sous vide" technology in the packaging of chilled and ready to serve food]. / Zastosowanie technologii "sous vide" do pakowania chlodzonych potraw gotowych do spozycia.

As chilled precooked dishes show limited to 3-5 days shelf life several additional factors have to be applied to extend it up to 21 or even 42 days as is sometimes allowed for sous vide technology products. Those factors comprise high hygienic standards for raw materials and premises as well as technological steps and parameters that efficiently destroy microbial contamination, and do not allow for recontamination or bacterial growth. Such steps include precooking which also means pasteurisation in high vacuum or anaerobic atmosphere in sealed pouches, blast chilling, low temperature storage parameters as well as high temperature of reheating process and quick serving procedures. Paper specifies parameters for each technological steps and presents microbiological requirements for final products. Sous vide technology allows for good quality and high nutritional value in soups, meats in sauces and stewed vegetables. It is used for individual consumer in chilled "ready to eat" line dishes in supermarkets and supplies such dishes for catering units.

[The most frequent causes of loss or impairment of vision in children and adolescents]. / Najczestsze przyczyny utraty i uposledzenia widzenia u dzieci i mlodziezy.

On the basis of examination of 100 persons aged 3-18 years registered in the Olsztyn Division of the Union of the Blind the authors determined the causes which led to the loss of vision or of its impairment. The most frequent cause of the invalidism of the visual system were: errors of refraction (32%), optic atrophy (24%), congenital cataract (16%), retinal and choroidal degeneration (9%), retrolental fibroplasia (6%), anophthalmia or malformation of the globe (4%), coloboma of the iris or choroid (3%), retinoblastoma (3%), injuries (2%) and congenital glaucoma (1%).

Prevalence of antibodies to Toxoplasma gondii in the Tel-Mond area.

Sera from 1,315 inhabitants of the Tel-Mond area were tested by the indirect immunofluorescent and Sabin Feldman tests for Toxoplasma antibodies. The overall prevalence of antibodies was 29.3%. Antibodies rose with age from 9.9% in the 1-4 year age-group up to 40.9% in the 45 age-group. There was no significant difference in prevalence of antibodies between the sexes. The prevalence of antibodies to Toxoplasma was lower in those born in Israel (21.2%) than in immigrants from Europe, America, Australia (49.4%), and Africa, Asia (40.8%) in the age groups of 20-45+. An extremely high prevalence of antibodies (41.5%) was found in Moshav Porat, a low socioeconomic settlement.

Trials and tribulations of country doctors: a qualitative study of doctor-patient relationships in rural Israel.

Rural areas of Israel are organized into small villages that attract physicians by offering inexpensive accommodation and the promise of a high quality of life. However, conflicts often arise in the relationship between the village residents and the doctor, leading to dissatisfaction and physician turnover. In order to examine the issues, we conducted a qualitative study of rural physicians using a group interviewing technique, called focus groups. The sample consisted of 46 physicians, aged between 35 and 45, of whom 60% were male. In the focus groups, the physicians mainly discussed issues of unclear boundaries between private life and physician roles, exaggerated expectations on the part of community members, difficulties with teamwork, the impact of the physician's family, work satisfaction, and burnout. Recommendations for physicians considering rural practice include making a careful and studied choice of a village before making a final decision, setting both clear professional limits and an overall time limit for service, allowing for mistakes, and organizing Balint-type physician support groups.

Adrenal insufficiency in a general hospital over a 14-year period.

Over a 14-year period, 26 patients with adrenal insufficiency of multiple etiology were evaluated. Eight were diagnosed at autopsy, six of whom had acute bilateral adrenal hemorrhage. Nine had chronic adrenal insufficiency. Of these, five were idiopathic and three had polyglandular disorders. Four others had tuberculosis. Six of nine patients with chronic adrenal insufficiency were hyperpigmented. Unusual manifestations of adrenal hypocorticism included hypercalcemia, flaccid paralysis, and joint contractures. The presence of multiple hormonal deficiencies focused the diagnosis on hypopituitarism. Two cases of isolated ACTH deficiency were detected. Patients with familial Mediterranean fever with amyloidosis commonly presented with reduced adrenal reserve rather than overt insufficiency. Metastatic cancer of the adrenal glands was a rare cause of reduced adrenal reserve.