Aleteo auricular con conducción auriculoventricular 1: 1 descripción de un caso atrial / Flutter with 1: 1 atrioventricular conduction. case report

El aleteo auricular (AA) con conducción auriculoventricular 1:1 es una condición de presentación infrecuente en la práctica clínica, se da debido a diversos factores entre los cuales los más importantes son la presencia de vías accesorias concomitantes o uso de ciertos medicamentos antiarrítmicos, el AA con conducción 1 a 1 cuando se desarrolla constituye una emergencia médica ya que tiene una frecuencia cardíaca regular y presenta QRS ancho puede confundirse con una taquicardia ventricular. Cuando se presenta esta condición se produce frecuentemente inestabilidad hemodinámica del paciente, por lo que se debe hacer su diagnóstico y tratamiento a la brevedad posible. En el presente reporte presentamos el caso de un paciente previamente portador de marcapasos que desarrolla una taquicardia de QRS ancho regular, que se diagnostica finalmente como AA con conducción 1 a 1, tratado con fármacos antiarrítmicos en primera instancia, logrando disminuir la frecuencia cardíaca y posteriormente la reversión del mismo.

The atrial flutter (AF) with 1 to 1 atrio-ventricular (AV) conduction it's a rare medical condition secondary to several factors among which the most important are the association whit AV accessory pathways, or secondary to the use of some antiarrhythmic drugs. The AF with 1 to 1 AV conduction is a medical emergency and since it has a regular heart rate and presents wide QRS complex it can be confused with a ventricular tachycardia. When this condition occurs, it leads to hemodynamic instability of the patient, and that is why the diagnosis and treatment of this entity should be made as soon as possible. In the present report we present the case of a patient whit a previous pacemaker implantation who develops a regular wide QRS tachycardia, which is diagnosed as AF with 1 to 1 conduction and treated with antiarrhythmic drugs, first achieving a reduction in the heart rate and subsequently reaching its reversion

Tension hydrothorax: Emergency decompression of a pleural cause of cardiac tamponade.

INTRODUCTION: A tension hydrothorax is defined as a massive pleural effusion presenting with hemodynamic abnormalities secondary to mediastinal compression. In these patients pleural volume increases intrathoracic pressure to the point of compromising diastolic filling and cardiac output simulating a cardiac tamponade physiology. This is an uncommon yet potentially fatal medical emergency that if left untreated may progress to cardiac arrest. Early detection and rapid intervention of these patients prevents cardiorespiratory collapse. CASE PRESENTATION: We present a two-case report of patients presenting with malignant tension hydrothoraxes decompressed with ultrasound-guided thoracentesis and tube thoracostomy in the ED. CONCLUSION: Although these life-saving decompressive interventions appear simple, not having proper training is an independent factor for chest tube and thoracentesis complications. Courses and simulation training can benefit physicians to minimize potential complications when managing emergency conditions such as tension hydrothoraxes which continue to be a medical challenge. Whether thoracentesis or thoracostomy is superior in managing this condition remains in debate and a clinical dilemma.

Factores asociados a la aceptación de donar órganos entre la población de Querétaro / Factors associated with organ donation acceptance by the population in Queretaro / Fatores associados à aceitação da população à doação de órgãos em Querétaro

La presente investigación busca determinar los factores asociados a la aceptación de donar órganos entre la población de Queré\r\n-\r\ntaro. Se realizó un estudio transversal comparativo en población ubicada en iglesias, parques recreativos, lugares de trabajo, zona \r\ncomercial y agrupaciones sociales de la ciudad de Querétaro, México. Se integraron dos grupos: con y sin aceptación de donar \r\nórganos, conformados por personas de 18 años o mayores, previo consentimiento informado. El tamaño de la muestra (n=117 \r\npersonas por grupo) se calculó mediante la fórmula de porcentajes para dos poblaciones con un nivel de confianza del 95%; se \r\nseleccionó a la población con la técnica muestral no aleatoria por cuota. Para analizar el fenómeno, se establecieron las siguientes \r\nvariables: características sociodemográficas, y factores económicos, sociales, culturales y psicológicos. El análisis estadístico incluyó \r\npromedios, desviación estándar, porcentajes, prueba de chi cuadrado, razón de momios, IC 95%, modelo y proyección. De acuerdo \r\ncon los resultados, los factores psicológicos asociados a la aceptación de donar de órganos fueron servir a una persona (RM=13,94; IC 95%; 1,86-104,19), satisfacción de ayudar (RM=7,39; IC 95%; 2,95-18,55) y alegría de que otra persona viva con algo mío (RM=4,61; \r\nIC 95%; 1,36-15,62). Se concluye que los factores psicosociales se asocian a la aceptación de donar órganos. El miedo en general y \r\nel miedo a una muerte prematura se asocian a la no aceptación de donar órganos.

Objective: to determine the factors associated with organ \r\ndonor status in the population of Queretaro. Method: a \r\ncross-sectional study was conducted in the general popu\r\n-\r\nlation found in churches, recreational parks, workplaces, \r\nshopping centers, and social gatherings in the city of Quere\r\n-\r\ntaro, Mexico. Two groups were created: organ donors, and \r\nnon-organ donors, both made up of people over 18 years old, \r\nwith informed consent. Data sample size (n = 117 people per \r\ngroup) was calculated using the percent formula for two popu\r\n-\r\nlations with a confidence level of 95%, and the population was \r\nselected with the nonrandom sampling technique by quota. \r\nTo analyze the phenomenon, the following variables were \r\nestablished: socio-demographic characteristics; economic, \r\nsocial, cultural and psychological factors. The statistical analysis \r\nincluded mean, standard deviation, percentages, chi square \r\ntest, odds ratio, 95% confidence interval, and projection model. \r\nResults: psychological factors associated with organ donor \r\nstatus are: helping a person (OR = 13.94; 95% CI 1.86 to 104.19), \r\nthe satisfaction of helping a person (OR = 7.39; 95% CI 2.95 to \r\n18.55) and the joy of another person living due to my organ \r\ndonation (OR = 4.61 person; 95% CI 1.36 to 15.62). Conclusions: \r\npsychosocial factors are associated with organ donor status. \r\nFears in general, and fear of premature death, are associated \r\nwith non-organ donors.

Objetivo: determinar fatores associados à aceitação da popu\r\n-\r\nlação à doação de órgãos em Querétaro. Método: um estudo \r\ntransversal comparativo foi realizado em população localizada \r\nem igrejas, parques recreativos, locais de trabalho, lojas e grupos \r\nsociais na cidade de Querétaro, México. Foram formados dois \r\ngrupos: com e sem a aceitação à doação de órgãos feita por \r\npessoas acima de 18, com consentimento prévio informado. O \r\ntamanho da amostra (n=117 pessoas por grupo) foi calculada \r\nutilizando a fórmula de percentagens para duas populações \r\ncom um nível de confiança de 95%, a população foi selecio\r\n-\r\nnada com a técnica de amostragem não aleatória por quota. \r\nPara analisar o fenômeno, estabeleceram-se as seguintes \r\nvariáveis: características sociodemográficas; factor econômico, \r\nsocial, cultural e psicológico. A análise estatística incluiu média, \r\ndesvio padrão, percentagens, teste do qui quadrado, razão \r\nde possibilidades, IC de 95%, modelo e projeção. Resultados: \r\nos fatores psicológicos associados com a aceitação à doação \r\nde órgãos são: servir uma pessoa (OR = 13,94; IC de 95%; 1,86-\r\n104,19), satisfação de ajudar (OR = 7,39; IC de 95%; 2,95-18,55) e \r\nalegria de que outra pessoa viva com algo meu (OR = 4,61; IC \r\nde 95%; 1,36-15,62). Conclusões: os fatores psicossociais asso\r\n-\r\nciados com a aceitação da doação de órgãos. O medo em \r\ngeral e o medo de uma morte prematura se associam à não \r\naceitação de doação de órgãos.

[The cost of polypharmacy in patients with type 2 diabetes mellitus]. / Costo de la polifarmacia en el paciente con diabetes mellitus tipo 2.

BACKGROUND: Polypharmacy or the concomitant use of three or more medications, may increase the complexity of health care and its costs. AIM: To determine the costs of polypharmacy in patients with Type 2 Diabetes Mellitus in a Mexican population sample. PATIENTS AND METHODS: Analysis of health care costs in 257 patients with Type 2 Diabetes Mellitus from two family care facilities, who had at least five consultations during one year. The cost of professional care by family physicians, pharmacological care and medications were considered to calculate the total expenses. The price of medications and the number of units consumed in one year were used to determine pharmacological expenses. Medications were grouped to determine costs derived from complications and concomitant diseases. Costs were calculated in US dollars (USD). RESULTS: The mean cost derived from family physician fees was USD 82.32 and from pharmacy fees USD 29.37. The mean cost of medications for diabetes treatment was USD 33.31, for the management of complications USD 13.9 and for management of concomitant diseases USD 23.7, rendering a total cost of USD 70.92. Thus, the total annual care cost of a diabetic patient was USD 182.61. CONCLUSIONS: Medications represent less than 50% of total expenses of diabetic patients with polypharmacy.

Factores de riesgo para sobrepeso y obesidad en lactantes / Risk factors for overweight and obesity in infants

Introduction: At one year of age, factors that favor the development of obesity and other metabolic disorders in later stages of life are present. Objective: To identify perinatal, societal, and dietary risk factors for excess weight and obesity in 12 months infants. Subjects and methods: Case-control studies with infants under the care of Family Medicine Units. These cases studied were overweight or obese children, and control cases were children at a healthy weight. Each group included 152 infants, who were evaluated based on their responses to a questionnaire, their records, and perinatal, societal, and dietary variables. Results: The variables with statistical significance were high pre-gestational weight, high gestational weight gain (OR 1.79-3.88), absence of breastfeeding and exclusive formula feeding (OR 2.02 and 1.75). Conclusion: In the presence of pre-pregnancy obesity and exclusive formula feeding, there is a 64.4% greater risk of becoming overweight or obese at 12 months old.

Introducción: Al año de vida existen factores que favorecen el desarrollo de obesidad y alteraciones metabólicas en etapas posteriores. Objetivo: Identificar factores de riesgo perinatales, sociales y alimentarios de sobrepeso y obesidad en lactantes de 12 meses de edad. Sujetos y método: Estudio de casos y controles en lactantes, que acuden a Unidades de Medicina Familiar, considerando casos; niños con sobrepeso u obesidad y controles: peso adecuado. Se incluyeron 152 lactantes por grupo, a los cuales se les estudió mediante un cuestionario y revisión de expedientes, variables perinatales, sociales y alimentarias. Resultados: Las variables con significancia estadística fueron: peso pre-gestacional de la madre elevado, incremento de peso gestacional elevado; OR 1,79 y 3,88 ausencia de lactancia materna y alimentación con fórmula láctea exclusiva, OR 2,02 y 1,75. Conclusión: en presencia de obesidad pregestacional y alimentación con formula láctea exclusiva, existe un riesgo 64,38% mayor de desarrollar sobrepeso u obesidad a los 12 meses de edad.

Costo de la polifarmacia en el paciente con diabetes mellitus tipo 2 / The cost of polypharmacy in patients with type 2 diabetes mellitus

Background: Polypharmacy or the concomitant use of three or more medications, may increase the complexity of health care and its costs. Aim: To determine the costs of polypharmacy in patients with Type 2 Diabetes Mellitus in a Mexican population sample. Patients and Methods: Analysis of health care costs in 257 patients with Type 2 Diabetes Mellitus from two family care facilities, who had at least five consultations during one year. The cost of professional care by family physicians, pharmacological care and medications were considered to calculate the total expenses. The price of medications and the number of units consumed in one year were used to determine pharmacological expenses. Medications were grouped to determine costs derived from complications and concomitant diseases. Costs were calculated in US dollars (USD). Results: The mean cost derived from family physician fees was USD 82.32 and from pharmacy fees USD 29.37. The mean cost of medications for diabetes treatment was USD 33.31, for the management of complications USD 13.9 and for management of concomitant diseases USD 23.7, rendering a total cost of USD 70.92. Thus, the total annual care cost of a diabetic patient was USD 182.61. Conclusions: Medications represent less than 50% of total expenses of diabetic patients with polypharmacy.

Costo-efectividad del programa del control del niño sano en el primer nivel de atención / Cost-effectivenesss of the program of control of the healthy child in the first level of care

Objective: To determine the cost-effectiveness of the control program of healthy children at the primary care level. Methodology: Children were divided into two groups, with and without allocation of milk, measured at 8,10 and 12 months of age. We evaluated 200 children with weight for age and heightfor age. Total cost estimate included the unit cost and service utilization in Family Medicine, EMI, Preventive Medicine, Laboratory, Office and Pharmacy. Results: The results of height for age alternative were most cost effective in all three measurements in the group without milk allocation of milk. For $ 3,000 invested in this option you get an effectiveness of85.36% at 12 months, 96.67% at 10 months and 98.05% at 8 months), while the effectiveness for the group without milk allocation was 69.53% at 12 months, 82.46% at 10 months and91.60% at 8 months. Conclusion: The most cost-effective control program for healthy children at the first level of care is the one withoyt allocation of milk.

Objetivo: Determinar la relación costo-efectividad del programa del control del niño sano en el primer nivel de atención. Metodología: Estudio de costo-efectividad de niños. Se definieron dos grupos con y sin dotación de leche. Se midió a los 8, 10 y 12 meses de edad. Se evaluaron 200 niños con el indicador peso para la edad y talla para la edad, la estimación del costo total incluyó el costo unitario y la utilización del servicio en Medicina Familiar, EMI, Medicina Preventiva, Laboratorio, Gabinete y Farmacia. Resultados: Para el indicador talla para la edad la alternativa con mejor relación costo efectividad en las tres mediciones es sin dotación láctea, por $3,000 invertidos en esta alternativa se obtiene una efectividad del 85.36% (12 meses), 96.67% (10 meses) y 98.05% (8 meses), en tanto la efectividad para el grupo con es de 69.53% (12 meses), 82.46% (10 meses) y 91.60% (8 meses).Conclusión: La mejor relación costo-efectividad del programa del control del niño sano en el primer nivel de atención es sin el otorgamiento de dotación láctea.

Evaluación geriátrica integral del adulto mayor / Cross sectional geriatric assessment of Mexican older people

Background: Due to the progressive aging of our population, it is imperative to evaluate the life conditions and health limitations of older people. Aim: To report the results of an integral geriatric evaluation of Mexican older people. Material and Methods: A cross-sectional assessment of 324 older subjects of a median age of 70 years (57 percent females) beneficiaries of the Mexican Institute of Social Security of the city of Querétaro. Social, demographic, medical, functional and cognitive variables were evaluated. Results: Of the studied subjects, 37 percent were illiterate, 61 percent lived with a partner and 47 percent were dedicated to household activities. Thirty three percent had visual impairment, 54 percent had hearing impairment, 39 percent had urinary incontinence, 26 percent reported falls in the last six months, 34 percent had nutritional problems, 38 percent were functionally dependent, 49 percent had sleeping problems, 25 percent had cognitive impairment and 25 percent had depression. Conclusions: The general health outlook of this population is encouraging, considering that more than half are not functionally impaired.

Costo oportunidad de adolescentes en unidades de medicina familiar / Opportunity cost for adolescents at family medicine clinics

Objective: To determine the opportunity cost for adolescents requiring care at Family Medicine Clinics. Material and Methods: Study of cost performed on 624 patients, 10-19 years of age, Family Medicine Clinics, Pharmacy and Laboratory. A conglomerate sample technique was used (Medical Unit), and proportional sampling internally. Several sociodemographic variables were evaluated, including transfer, waiting time and care. Statistical evaluation included averages, percentages, and confidence intervals of 95 percent. Results: The cost-opportunity for Family Medicine and Pharmacy in the situations evaluated was $10.22 for the teenager, $71.43 for the first family member, and $14.28 for the second person accompanying the child. When they attend all three services, the cost is $12.26, $82.71 and $16.54 respectively. A weighted average cost of opportunity IFOR all three services is $93.18. Conclusions: The largest cost of opportunity for adolescents occurs when waiting for care in Family Medicine. It is suggested that strategies be implemented to decrese waiting times in the various services.

Objetivo. Determinar el costo oportunidad de los adolescentes que demandan atención en las Unidades de Medicina Familiar. Material y Métodos. Estudio de costo oportunidad realizado en 624 usuarios de 10 a 19 años de edad atendidos en tres Unidades de Medicina Familiar, en los servicios de Medicina Familiar, Farmacia y Laboratorio. Se empleó la técnica muestral por conglomerados (Unidad Médica) y al interior por cuota. Se estudiaron variables sociodemográficas y número de acompañantes; se estimó el costo oportunidad para el traslado, espera y atención. El análisis estadístico incluyó promedios, porcentajes e intervalos de confianza del 95 por ciento. Resultados: El costo oportunidad promedio para Medicina Familiar y Farmacia es de $10.22 para el adolescente, de S 71.43 para el acompañante 1 y de $14.28 para el acompañante 2; cuando acuden a los tres servicios es de $12.26, $82.71 y $16.54 respectivamente. El costo oportunidad promedio ponderado cuando acuden a los tres servicios es de $93.18. Conclusión: El mayor costo oportunidad para los adolescentes corresponde a la espera en el servicio de Medicina Familiar. Por lo que se sugiere implementar estrategias que disminuyan el tiempo de espera en los diferentes servicios.

Estereotipos negativos de la vejez en personal de salud de un Hospital de la Ciudad de Querétaro, México / Prevalence of negative stereotypes towards old age among personnel of a general hospital

Background: Social representations are value systems. Social stereotypes are a social consensus of traits associated with a specific group. Stereotypes about older subjects, generally have negative connotations. Aim: To assess the prevalence of negative stereotypes towards older subjects among health care personnel. Material and Methods: A questionnaire about stereotypes towards old age, with Likert type questions that included health, social motivations and personality-character domains, was applied to 52 doctors, 12 residents, 80 general nurses, 36 auxiliary nurses, four social workers and 10 medical assistants, working at a general hospital. Results: The mean age of the professionals who answered the questionnaire was 38 years (95 percent confidence intervals (CI) 37-39 years) and 78 percent were women. The prevalence of a Global negative stereotype was 65.0 percent(95 percent CI: 59.5-70.5). The figure for the health domain was 64.5 percent (IC95 percent; 59.0-70.0), for the social motivation domain was 60 percent(5 percentCI: 54.3-65.7) and for the character personality domain was 64 percent (95 percentCI: 58.4-69.6). Conclusions: There is a high prevalence of a negative stereotype towards old age among health care personnel.

Efectos de una intervención en la utilización del servicio de nutrición en México / Effect of an intervention in the use of the service of nutrition in Mexico

Se aplicó una estrategia de comunicación para mejorar la utilización del servicio de nutrición previa identificación de las barreras de acceso. La intervención consistió en establecer libre demanda al servicio y se utilizaron carteles, volantes y mensajes por altavoz para motivar a la población en el uso del servicio. El 40 por ciento de la población que utilizó el servicio después de la estrategia de medios, lo hizo de manera espontánea. El análisis por tipo de medio de comunicación, mostró diferencias intragrupos en todos los indicadores de uso. En conclusión, todas las estrategias fueron buenas; sin embargo, comparaciones post hoc señalaron un mayor impacto del volante en incremento en la demanda espontánea de consultas.

Evolución a un año de los efectos adversos, en una cohorte de pacientes con implante subdérmico de Desogestrel / Adverse effects of subdermal Desogestrel implants: one year evolution

Objetivo: El propósito de la investigación fue evaluar la evolución a un año los efectos adversos en una cohorte de pacientes con implante subdérmico de desogestrel. Método: Se incluyeron pacientes portadoras de implante que tenían como mínimo tres meses de uso, previo consentimiento informado. Se realizaron 4 mediciones en forma trimestral, registrándose los efectos más frecuentes referidos por la paciente. El análisis incluyó porcentajes, promedios e intervalos de confianza al 95 por ciento. Resultados: Se estudiaron 50 pacientes, los efectos adversos presentados con mayor frecuencia en el primer trimestre fueron alteraciones del ciclo 48 por ciento, mastalgia 46 por ciento, amenorrea 40 por ciento, mareo 40 por ciento, cefalea 40 por ciento, náuseas 30 por ciento, acné 28 por ciento, aumento de peso 26 por ciento y dolor local 10 por ciento. Se observó al final del tercer trimestre reducción de la cefalea, mastalgia y mareo (p<0,05); para el cuarto trimestre las náuseas y las alteraciones del ciclo (p<0,05). El 11,1 por ciento de las pacientes desertaron del método al final del estudio. Se observó que el uso del desogestrel tuvo un valor estadísticamente significativo para el control de la dismenorrea (p<0,05) al final del cuarto trimestre de uso. Conclusión: Los implantes de desogestrel tienen efectos adversos importantes en los primeros meses de uso para disminuir la mayoría de ellos al final del primer año.

Social networks and cancer screening in four U.S. Hispanic groups.

BACKGROUND: Evidence shows that social relationships play an important role in health and health behavior. We examined the relationship between social networks and cancer screening among four U.S. Hispanic groups. METHODS: We used telephone surveys to collect data in eight U.S. regions that have concentrations of diverse Hispanic-origin populations. We interviewed 8903 Hispanic adults, for a response rate of 83%; analysis was restricted to the 2383 women aged > or =40. As a measure of social integration, we formed a social network index from items on the number of close relatives and friends, frequency of contact, and church membership. We used logistic regression to estimate the effects of social integration on screening, adjusting for sociodemographic factors. RESULTS: Among Mexican, Cuban, and Central-American women, the effect of social integration on mammography screening was slight. The odds ratios (OR) per unit change in social integration category ranged from 1.16 to 1.22 with confidence intervals (CI) that overlapped with the null. For Pap smear screening, the effect was strongest among Mexican-American women (OR=1.44, 95% CI=1.21 to 1.72), but also evident among Central-American women (OR=1.22, 95% CI=0.72 to 2.06) and Cuban women (OR = 1.25, 95% CI = 0.81 to 1.93). Among Puerto Rican women, social integration had no effect on either mammography (OR=1.03) or Pap smear screening (OR=1.08). CONCLUSIONS: Independent of socioeconomic factors, social integration appears to influence cancer screening participation of Hispanic women. The modest effect is not universal across Hispanic groups and was stronger for Pap smear than for mammography screening behavior. Researchers should recognize Hispanic group differences in social network characteristics and the potential of social networks to change screening behavior.

Breast cancer screening in regional Hispanic populations.

Although Hispanics' use of breast cancer screening services has been investigated, to date there have been no published studies of distinct Hispanic populations in different areas of the country. Using the diverse populations and sites involved in the National Hispanic Leadership Initiative on Cancer 'En Acción', this study examines ethno-regional differences in breast cancer screening rates among these groups and explores the correlates of screening participation. Data collected through telephone surveys were analyzed for women 40 years of age and older (n = 2082). After controlling for demographic variables traditionally related to breast cancer screening rates, it was found that ethno-regional differences in breast cancer screening practices clearly persisted. In addition to traditional demographic factors, other variables evidently underlie differences in Hispanics' utilization of breast cancer screening services. These variables may be cultural and should be investigated in future research. Meanwhile, researchers should not refer to the 'Hispanic' population at large without identifying, addressing and clarifying the ethno-regional characteristics of their samples.

Are obstetrical personnel required for intraoperative fetal monitoring during nonobstetric surgery?

OBJECTIVE: To determine if the scientific literature supports the practice of electronic monitoring of the fetal heart rate (FHR) during nonobstetric surgery. STUDY DESIGN: A search of the literature from 1966 to 1995 was performed using MEDLINE. RESULTS: No fetal hypoxic mortality or morbidity has been documented from nonobstetric surgery without occurrence of a maternal hypoxic complication regardless of the use of FHR monitoring or whether alterations of the FHR occurred. CONCLUSIONS: Fetal monitoring is an indirect assessment of maternal anesthetic and surgical management that is not as specific or effective as direct assessment of the maternal parameters to detect respiratory compromise. Current clinical evidence obtained does not substantiate the need for obstetric personnel to monitor FHR changes during surgical procedures because no change in fetal outcome has been documented.

Advancing the role of participatory communication in the diffusion of cancer screening among Hispanics.

Based on previously demonstrated methods, a cancer prevention program combining media and interpersonal communication was conducted in a Texas border city (Brownsville) in 1995-1996. To evaluate the program a quasi-experimental panel design study followed 107 women in a program site and 105 women in a comparison site from 1994 to 1996. Women in the program site reported an increase in levels of Pap screening adherence.

Changes in pupil size induced by phacoemulsification and posterior chamber lens implantation: consequences for multifocal lenses.

PURPOSE: Because the optical performance of eyes implanted with multifocal intraocular lenses will theoretically depend upon the size and position of the pupil relative to the near and distance zones of the lens, we designed a study to determine whether preoperative pupil size is useful in predicting the postoperative pupil size of patients having phacoemulsification with posterior chamber lens implantation. SETTING: Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas. METHODS: We prospectively measured pupil sizes preoperatively and postoperatively in 71 consecutive patients who had phacoemulsification with posterior chamber lens implantation. Pupil sizes were photographed under five lighting and viewing conditions that simulated a range of normal functional situations. RESULTS: The mean change in preoperative to postoperative pupil size was less than 0.5 mm in all five testing conditions. However, changes in pupil diameter of 1.0 mm or more were noted in approximately 10% of patients in each testing situation. Sex, iris color, and the presence or absence of intraoperative iris trauma were not predictive factors for determining which patients sustained large postoperative changes in pupil size. CONCLUSIONS: Preoperative pupil size does not predict postoperative size with sufficient consistency to ensure a good match between pupil diameter and the zone sizes of multizone multifocal intraocular lenses.

Hyperopia correction by noncontact holmium:YAG laser thermal keratoplasty. Clinical study with two-year follow-up.

BACKGROUND: Thermal keratoplasty to correct hyperopia has been attempted with nonlaser and laser devices. Problems have included long-term regression and irregular induced astigmatism. The present clinical study was performed to investigate the safety, efficacy, and stability of a noncontact mode of holmium: YAG laser energy delivery and a modified laser thermal keratoplasty treatment procedure for correction of low hyperopia. METHODS: Seventeen patients underwent noncontact holmium: YAG laser thermal keratoplasty in their nondominant eyes for correction of hyperopia of up to 3.00 diopters. Treatment parameters included simultaneous delivery of eight holmium: YAG laser spots in a symmetrical octagonal array with a centerline diameter of 6mm, 10 pulses of laser light at 5-Hz pulse repetition frequency, and pulse energies of 159 to 199mJ. Follow-up was 2 years in 15 of 17 patients. RESULTS: In the 15 eyes examined at 2 years after surgery, mean uncorrected distance Snellen visual acuity improved from 20/125-1 to 20/50-2. The mean change in spherical equivalent of subjective manifest refraction was -0.79 diopter. Eleven of these 15 eyes (73%) had a mean refractive correction of -1.1 diopters (range, -0.38 to -2.63 diopters); regression between 14 days and 2 years was 0.2 diopter. Four eyes (27%) had no persistent refractive correction (within +/- 0.25 diopter). Mean induced refractive astigmatism was 0.18 diopter. None of the eyes lost two or more lines of spectacle-corrected distance vision. The amount of refractive correction at 2 years after surgery was correlated to the treatment pulse energy and the volume of the opacified corneal tissue observed immediately after treatment. CONCLUSIONS: This technique of noncontact laser thermal keratoplasty produced safe, effective, and persistent corrections of low hyperopia in the majority of treated eyes.

Targeting Hispanic populations: future research and prevention strategies.

Minority populations face a wide variety of economic, institutional, and cultural barriers to health care. These barriers and low levels of education and income pose significant challenges for health professionals in developing cancer research and prevention-control strategies. It is suggested that specific segments of Hispanic populations fit the model of an underdeveloped country in the intermediate stage of epidemiological transition. Since noncommunicable diseases have not yet fully emerged in some of these Hispanic population segments, the opportunity exists to apply primordial prevention strategies. Such campaigns would focus on dissuading members of these populations from adopting negative health behaviors while promoting positive lifestyle choices. Optimal programs would increase cancer screening participation and discourage risk behaviors through community-oriented, population-based interventions. Future directions in prevention and control efforts for minority populations should include expanded health insurance coverage, improved access to health care, greater emphasis on minority recruitment in health care fields, focused epidemiologic and clinical research, and identification and replication of effective components within existing prevention-control programs.

The emerging Hispanic population: a foundation for cancer prevention and control.

Although making up only 9% of the U.S. population and concentrated in urban areas of a few states, Hispanics are found throughout the country and represent a mix of historical and cultural backgrounds. This diverse group cuts across racial and ethnic lines, with origins in various countries of Europe and North, Central, and South America. The Hispanic population has several distinguishing demographic characteristics, including its rapid growth rate, relative youth, and low educational and socioeconomic levels. However, considerable differences exist among Hispanic groups, particularly in median age, household size, education, and family income. The majority of Hispanics face barriers to health care access, including a lack of health insurance coverage, underrepresentation in health care fields, and cultural and language differences. These distinct demographic characteristics and barriers have a direct impact on the risk of cancer in Hispanics and on the development of prevention and control strategies. The purpose of this review is to examine the demographic and socioeconomic characteristics of Hispanics and issues of access to health care among this population within the context of cancer prevention and control.