Asunto(s)
Antineoplásicos/uso terapéutico , Hemangioendotelioma/tratamiento farmacológico , Neoplasias Hepáticas/tratamiento farmacológico , Propranolol/uso terapéutico , Antagonistas de Receptores Adrenérgicos beta 2/administración & dosificación , Antagonistas de Receptores Adrenérgicos beta 2/efectos adversos , Antagonistas de Receptores Adrenérgicos beta 2/uso terapéutico , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Hipotiroidismo Congénito/complicaciones , Hipotiroidismo Congénito/tratamiento farmacológico , Monitoreo de Drogas , Femenino , Hemangioendotelioma/complicaciones , Hemangioendotelioma/congénito , Terapia de Reemplazo de Hormonas , Humanos , Recién Nacido , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/congénito , Neoplasias Primarias Múltiples/complicaciones , Neoplasias Primarias Múltiples/congénito , Neoplasias Primarias Múltiples/tratamiento farmacológico , Propranolol/administración & dosificación , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/congénito , Neoplasias Cutáneas/tratamiento farmacológico , Tiroxina/uso terapéutico , Vasoconstrictores/administración & dosificación , Vasoconstrictores/efectos adversos , Vasoconstrictores/uso terapéuticoRESUMEN
OBJECTIVE: To compare the content, quality, and cost of recommendations for children made by complementary and alternative medicine (CAM) retailers within 2 New York City neighborhoods of divergent socioeconomic status (SES). METHODS: Posing as consumers, researchers sought recommendations from CAM retailers for 2 clinical scenarios: 1) a febrile 6-week-old and 2) a 4-year-old with an upper respiratory infection (URI). All retailers selling CAM therapies outside the direction of a licensed provider within East Harlem (EH) and the Upper East Side (UES) were eligible and mapped. The febrile infant scenario was posed at sites in business in March (n = 23) and the URI scenario at sites that remained in business in April (n = 20) of 2004. RESULTS: In response to the febrile infant scenario, 33% of UES retailers referred to a MD, 0% to the emergency department, and 47% made other recommendations-of which 43% were not indicated. In EH, 50% referred to a MD, 5% to the emergency department, and 37% made other recommendations. The mean price of UES recommendations was Dollars 9.66, whereas EH was Dollars 2.33 (P = .04). In response to the URI scenario, 93% of UES and 83% of EH retailers made recommendations. The mean price of UES recommendations was Dollars 10.55 while EH was Dollars 4.26 (P = .002). CONCLUSIONS: Complementary and alternative medicine retailers made numerous recommendations for children, including some that were contraindicated for age. East Harlem retailers tended to refer an infant with a potentially serious condition to the emergency department or to an MD and made less expensive recommendations than their UES counterparts.
Asunto(s)
Servicios de Salud del Niño/normas , Terapias Complementarias/normas , Grupos Minoritarios/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Características de la Residencia/clasificación , Clase Social , Servicios Urbanos de Salud/clasificación , Negro o Afroamericano , Niño , Servicios de Salud del Niño/economía , Terapias Complementarias/economía , Hispánicos o Latinos , Humanos , Ciudad de Nueva York , Pautas de la Práctica en Medicina/economía , Derivación y Consulta/economía , Factores Socioeconómicos , Servicios Urbanos de Salud/economía , Servicios Urbanos de Salud/normas , Población BlancaRESUMEN
The use of pulsed field gel electrophoresis and neisserial lipoprotein gene sequencing for subtyping Neisseria gonorrhoeae has not been reported in the evaluation of sexually abused children. We report the application and implications of combining pulsed field gel electrophoresis and lipoprotein subtyping in the evaluation of a 3-year-old girl with N. gonorrhoeae infection.
Asunto(s)
Proteínas de la Membrana Bacteriana Externa/genética , Técnicas de Tipificación Bacteriana/métodos , Abuso Sexual Infantil/diagnóstico , Medicina Legal/métodos , Gonorrea/microbiología , Neisseria gonorrhoeae/clasificación , Adolescente , Preescolar , Electroforesis en Gel de Campo Pulsado , Femenino , Genotipo , Humanos , Masculino , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/aislamiento & purificación , Análisis de Secuencia de ADNRESUMEN
This review discusses the forensic medical and psychological assessments of children and adolescents suspected of being victims of sexual or physical abuse/neglect. Evaluation of the whole child and the need to minimize trauma during the investigative and assessment processes are stressed. The forensic medical examination is reviewed, including the specifics of the pediatric anogenital examination. The key components of the forensic medical examination in sexual assault cases are also reviewed, with particular attention to maintaining the integrity of the process. Special emphasis is placed on the forensic interview in child sexual abuse cases, the best evidence available and areas in need of further research.
Asunto(s)
Maltrato a los Niños/diagnóstico , Medicina Legal/normas , Adolescente , Niño , Abuso Sexual Infantil/diagnóstico , Defensa del Niño , Víctimas de Crimen/psicología , Medicina Legal/métodos , Humanos , Entrevista Psicológica/normas , Examen Físico/psicología , Examen Físico/normas , Guías de Práctica Clínica como Asunto , Estados UnidosRESUMEN
There is considerable interobserver variation in the diagnosis of low-grade squamous intraepithelial lesion that involves mature squamous epithelium. Our aim was to evaluate the utility of MIB-1 immunostaining as an adjunct test to increase diagnostic accuracy. Consecutive cervical biopsies originally diagnosed as normal (n = 26) or low-grade squamous intraepithelial lesion (n = 23) were reviewed by three pathologists to obtain a consensus diagnosis. MIB-1 immunostaining was performed, and positive staining was defined as a cluster of at least two stained nuclei in the upper two thirds of the epithelial thickness. Human papillomavirus (HPV) DNA detection was performed using a polymerase chain reaction assay. All cases were subsequently reclassified as low-grade squamous intraepithelial lesion (LSIL) or normal (NL) when two or three of three gold standard criteria were satisfied (LSIL gold standard criteria = consensus diagnosis of LSIL, HPV+, MIB-1+; NL gold standard criteria = consensus diagnosis of NL, HPV-, MIB-1-). Using the gold standard diagnoses, we have identified that 14 normal cases (36%) were originally overdiagnosed as LSIL, and one LSIL case (10%) was originally underdiagnosed as normal. All MIB-1-positive cases were HPV+ and identified as LSIL in the consensus review. All MIB-1-negative cases were NL by gold standard criteria. The sensitivity (1.0) and the specificity (1.0) of MIB-1 staining for identifying LSIL were superior to the sensitivity (0.9) and the specificity (0.8) of HPV testing. In conclusion, MIB-1 is a highly sensitive and specific marker for identifying low-grade squamous intraepithelial lesion and is helpful in verifying the diagnosis of equivocal cases.