Evaluation of the effect of endovascular options on infrarenal abdominal aortic aneurysm repair.

Endovascular devices designed to exclude flow to infrarenal abdominal aortic aneurysms (AAA) were approved by the Food and Drug Administration in the United States in 1999. This action allowed widespread use of this technology for AAA exclusion. The purpose of this report is to examine trends for use of these modalities, rates of rupture of AAA, and to compare results of open AAA repair with endovascular repair. Results were collected for all hospitals, except for Veterans Administration hospitals, by a state-wide repository. Data for the years 1996 through 1998 and 2001 through 2002 were evaluated, and data from 1999 through 2000 were excluded because no separate codes were available to distinguish between open and endovascular repair. The information gathered is based on the All Patient Refined Diagnostic Related Group (APRDRG; 3M, St. Paul, MN). An average of 718 open, elective AAA was performed between 1996 and 1998. This dropped to 503 open repairs from 2001 to 2002 (P < 0.005). During that same interval, 308 endovascular elective AAA repairs were performed, therefore the total rate of elective repair increased by 100. The average rate of ruptured AAA repairs from 1996 to 1998 was 121 per year, and this dropped to 89 from 2001 to 2002 (P < 0.005). The mortality of open AAA repair during the 1996 to 1998 and 2001 to 2002 intervals was unchanged (4.7%). Mortality from endovascular AAA repair between 2001 and 2002 was 1.9 per cent (P = 0.003). Major morbidity was 14.5 per cent for open, elective AAA repair and 6.3 per cent for endovascular elective repair from 2001 to 2002 (P < 0.001). These data suggest that the advent of endovascular AAA repair has contributed to a reduction in the rate of ruptured AAA repairs, an increase in total procedures performed, and a significant decrease in perioperative deaths and major complications when compared with open AAA repair.

Carotid endarterectomy: update on the gold standard treatment for carotid stenosis.

Many prospective, randomized clinical trials evaluating the safety and efficacy of carotid endarterectomy (CEA) versus medical management in the prevention of ischemic stroke were performed in the 1990s. Clinical trials are underway that will compare CEA outcomes to carotid stenting; however, relatively few studies have examined the outcomes of modern CEA. The purpose of this report is to examine current outcomes of CEA and evaluate hospital costs and length of stay. Statewide results were collected for all hospitals, except Veterans Administration hospitals, by Virginia Health Information (VHI). Data for the years 1997-2001 were evaluated, and data were based on the All Patient Refined Diagnostic Related Group (APR-DRG; 3M Company). A total of 14,095 CEAs were performed in a 5-year period. The mortality of patients undergoing CEA was 0.5 per cent. The stroke rate was 1 per cent overall and decreased each year of the study. Mean and median lengths of hospital stay were 3 and 2 days, respectively. Length of stay decreased over the course of this study. Mean and median hospital costs were 14,331 dollars and 11,268 dollars. Higher rates of mortality and stroke and higher costs were observed at low-volume hospitals. The need for CEA is substantial. CEA is safe and inexpensive. The data presented here demonstrates continued refinement in CEA, leading to a very low rate of perioperative adverse events, declining lengths of stay, and low hospital costs.

Examination of sex as an independent risk factor for adverse events after carotid endarterectomy.

BACKGROUND: The incidence of adverse events after carotid endarterectomy (CEA) for women compared with men is controversial. This report compares the incidence of perioperative stroke and death in men and women by examining the effect of comorbidities and hospital setting on CEA outcomes. METHODS: All CEAs performed in non-Federal acute-care Virginia hospitals between 1997 and 2001 were reviewed. Patient demographics, comorbidities, and hospital characteristics were compared for possible relationships to perioperative adverse events. RESULTS: A total of 14,095 CEAs were performed in 34 urban and 28 rural hospitals (9 high-volume and 53 low-volume hospitals); 42% were performed on women, and 58% were performed on men. Women experienced a significantly higher stroke rate (1.23%) than men (0.87%; P = .04) with bivariate analysis. However, logistic regression analysis of comorbidities and hospital settings demonstrated that sex was actually not independently related to adverse outcomes in CEA ( P = .08). Preoperative neurologic symptoms could not be evaluated as risk factors for adverse events. Acute coronary ischemia, history of arrhythmia, end-stage renal disease, nonwhite race, advanced age, and low hospital volume were all significantly related to mortality. History of arrhythmia was the only factor that was significantly related to the incidence of stroke. CONCLUSIONS: Logistic regression analysis of comorbidities and hospital setting indicated that female sex is not independently associated with higher mortality or a higher stroke rate during CEA. These data indicate that patients with carotid stenosis frequently have multiple medical problems that need to be carefully examined and controlled before any single patient or hospital factor is designated as significantly related to adverse outcomes.

Measuring risk and protective factors for substance use, delinquency, and other adolescent problem behaviors. The Communities That Care Youth Survey.

Risk and protective factors predictive of adolescent problem behaviors such as substance abuse and delinquency are promising targets for preventive intervention. Community planners should assess and target risk and protective factors when designing prevention programs. This study describes the development, reliability, and validity of a self-report survey instrument for adolescents ages 11 to 18 that measures an array of risk and protective factors across multiple ecological domains as well as adolescent problem behaviors. The instrument can be used to assess the epidemiology of risk and protection in youth populations and to prioritize specific risk and protective factors in specific populations as targets for preventive intervention.

[Ergonomics in planning and reconstruction]. / L'ergonomia nella progettazione e ristrutturazione.

The state of well being of people is not represented only by any illness, but also by the satisfaction of all environmental components around him. For this reason, the hospitals demand new and more project attentions and in particular they demand specific attentions for all the environmental qualities (light, colours, indoor air qualities, and temperature), the equipment, the furniture and the privacy. This new attention to the requirements of people, during the phase of planning, needs the ergonomic studies. This kind of discipline, in fact, has got the objective of good relationships between men and context where they live. The study of ergonomic qualities needs different competence of multiple areas of acquaintance, that collaborate to analyse the requirements of sanitary structure, and in particular they analyse needs of different categories of people that work or stay in this place (the patients, visitors and sanitary staff). Moreover ergonomic studies concurs to analyse the various factors of complexity, of the buildings, that are very important for the project of hospital. From the scientific literature, we say that some physical environmental characteristics (light, colour, noise,) can influence the psychological conditions of people, and in particular they can generate three different categories of reactions: behavioural, neuropsychological, neuroendocrinal. For this reason the study of all the environmental factors, simple and composed, is a primary necessity in the hospital planning. In this way we can guarantee to the patient, a better sanitary service and a better comfort, and we can guarantee to all sanitary staff adequate conditions of security and functionality.

The quantity and quality of the social networks of young people with early psychosis compared with closely matched controls.

This study compares the social networks and perceived social support of 26 people with early psychosis and 26 people without a mental illness. The two groups were closely matched for age, sex, education level, and employment and relationship status, and had equivalent levels of depression. There were no differences between the two groups in the amount of perceived social support, number of family members, and number of participants with acquaintances. However, the psychosis group identified significantly smaller networks, t (50)=-2.34, P=0.024, with fewer friends, t (48)=-3.61, P=0.001, fewer people to turn to in a crisis, t (22.97)=-2.34, P=0.028, and a higher likelihood of service providers as members, chi(2)(1)=7.02, P=0.008. Given the important relationship between strong social networks and high levels of community functioning and tenure, future research needs to evaluate the type of social support most beneficial for people with early psychosis and to develop strategies to maintain and facilitate that support.

At-risk and not at-risk primary school children: an examination of goal orientations and social reputations.

AIMS: The purpose of the present research was to examine whether at-risk and not at-risk primary school aged students differ in two social and psychological domains (future goal orientations and social reputation). SAMPLE: A total of 886 years 5, 6 and 7 students from five primary schools in the Brisbane metropolitan area of Queensland, Australia, participated in the study. METHOD: The Children's Activity Questionnaire which constitutes three parts (demographic information, the Importance of Goals Scale, and the Reputation Enhancement Scale) was administered under standardised conditions. RESULTS: A series of multivariate analyses of variance (MANOVA) and univariate F-tests performed on each of the sets of dependent variables (goal orientations and reputation enhancement) revealed significant differences between the at-risk and not at-risk participants on both goals and reputation. CONCLUSIONS: Not at-risk children sought to attain an Academic Image through education and interpersonal goals, whereas at-risk children sought a Social Image and attached greater importance to physical goals. In line with this, children in the not at-risk group perceived themselves and ideally wished to be perceived as a conforming person, while at-risk children perceived themselves and ideally wished to be perceived as non-conforming. Significant gender differences were also found on both sets of dependent variables. COMMENT: The findings are compared to recent research conducted with high school adolescents.

[The environmental characteristics of patients' rooms and their interactions with the lifting of patients]. / Caratteristiche ambientali del reparto di degenza e loro interazioni con la movimentazione del paziente.

The Law (Presidential Decree) of 14/1/97 requested the regions of Italy to define and develop procedures for the accreditation of their health facilities. Since accreditation promotes the quality of the system, the support of ergonomics can be fundamental. Ergonomics, whose quality objective is harmony of the environment-man-object relationship, is in a position to make a major contribution to the complete application of the procedures for quality certification (ISO regulation 9000) and of the regulations regarding mandatory safety regulations (Law 626/94). The present paper analyzes the tasks of health workers vis-a-vis patients, highlighting the improvement or worsening effect of environmental features which not only have a direct effect on movements and general activity but also have an indirect effect on psychological and behavioural conditions. The first requirement that should be taken into consideration in environments that are also used by patients is that everything that can facilitate or make their walking and access to facilities self-sufficient will certainly make the healthcare workers' tasks easier, which can then be limited to lifting required for treatment and washing. The ward, especially, is an area that is extremely important from the point of view of design because it is where the patient does practically everything and where the staff, too, are mainly engaged in hygiene/treatment tasks, involving both patients and their relatives. The bed must be able to be easily used by potentially disabled patients who have difficulty in walking and moving. The beds should therefore be equipped with or have close by handles and rails that assist the patient to lie down, get up and move from the bed; the bed should also have a manual or electrical device to adjust the height (from 40 to 70 cm) and have four wheels (that can each be blocked) to make it easier to move. The supporting legs should occupy as little space as possible and should not interfere with wheelchairs or other walking aids or with the movements of the staff. The head and foot-boards should have parts that can be used as grips. The space between both sides of the beds should be at least 90 cm and the space between headboard and wall 120 cm; bedside tables should be no deeper than 30 cm and be fitted with wheels. On the question of space distribution design, another important requirement is flexibility. Adequate flexibility of space distribution together with adaptable technological systems mean that the spaces and equipment of the ward can be easily adapted to the great variety of needs.

Cigarette use by adolescents: attitude-behavior relationships.

Structural equation models were used to test the effectiveness of various theories in predicting cigarette smoking among adolescents. Maximum-likelihood estimation, as implemented in LISREL for Windows 8.12, was used to compare the theory of reasoned action (TRA), the theory of planned behavior, and a modified version of the theory of reasoned action incorporating past behavior. Respondents consisted of 225 high school students who were questioned in 1994 about their attitudes, subjective norms, perceived behavioral control, past behavior, intentions, and actual behavior relating to the use of cigarettes. Results indicated that the modification of the TRA incorporating past behavior provided a marginally better fit than the other models. For this group of high school students, attitudes toward smoking, past behavior in relation to smoking, and perceptions of what significant others think they should do were significant predictors of their intentions to smoke. Intentions, together with past behavior, predicted their actual behavior. The models used in the present research show that this behavior can be explained with reference to a small number of key variables which are useful for furthering our understanding of the structure of adolescent smoking.

Effects of background noise on click-evoked otoacoustic emissions.

OBJECTIVE: To investigate the effect of increased levels of background noise on click-evoked otoacoustic emission (CEOAE) recordings and to compare the effectiveness of the default CEOAE program with the QuickScreen CEOAE program in increased levels of noise, using an Otodynamics ILO88 recording device. DESIGN: The right ears of 40 young adult women with normal hearing were assessed using CEOAEs under four different noise conditions and with two different methods of data collection. The noise conditions were in quiet, 50 dB A, 55 dB A, and 60 dB A of white noise. Data were collected at each noise level in the default mode and also using the ILO88 QuickScreen program. RESULTS: There was a significant change in a number of important CEOAE output parameters with increased noise. In the default mode, mean whole wave reproducibility was 89.2% in quiet but declined to 85% with 50 dB A of white noise, 65% at 55 dB A and 20% at 60 dB A. The QuickScreen program proved more robust to the effects of noise than the default. In that mode, mean whole wave reproducibility was 91.7% in quiet, 92.5% with 50 dB A of white noise, 82.5% at 55 dB A and 45% at 60 dB A. CONCLUSIONS: The findings of the study indicate ambient noise levels for accurate CEOAE recording should not exceed 50 to 55 dB A of noise and alternatives to the default program should be considered in non-sound-treated situations.

Stress and coping in early psychosis. Role of symptoms, self-efficacy, and social support in coping with stress.

BACKGROUND: Although coping with stress is important in early psychosis, little is known about how this population copes with the range of stressors they encounter in their daily life. This study aims to identify how people with early psychosis cope with a range of stressful situations and to identify what factors might influence their use of coping strategies. METHOD: Participants included a clinical group of 50 people with early psychosis and a non-clinical group of 22 people matched on age and gender. Data were obtained on symptomatology and social support for the clinical group, and stress and coping, and self-efficacy for all participants. RESULTS: The clinical group reported coping less well than the non-clinical group and they most commonly used emotion-focused coping. For the clinical group, effective coping correlated with less severe negative symptoms, greater perceived self-efficacy, social support and greater use of problem-focused coping. Self-efficacy and social support predicted increased frequency of the use of problem-focused coping. CONCLUSION: People with early psychosis who have greater feelings of self-efficacy and perceived social support, and the flexible use of problem-focused coping strategies, appear to be more likely to cope with day-to-day stressors.

Cognitive-linguistic subgroups in closed-head injury.

This study examined variability in the interrelationship between language skill and neuropsychological function within a group of 25 severe closed head injury (CHI) subjects and 23 matched controls. All subjects underwent a battery of standardized language and neuropsychological tests. Cluster analyses were conducted to determine whether the CHI sample was universally or differentially impaired. Further subgroup analysis using a Q-type factor analysis outlined the differences in performance profiles within the group of CHI subjects. Results support the hypothesis that while some deficits were common to all CHI subjects, impairments delineated by whole group analysis do not necessarily represent universal impairments. In particular, ability to perform tasks involving auditory comprehension, naming, verbal memory, visual memory and visuospatial skills appeared to be important components in group differentiation. The cognitive-linguistic impairments which were common to all CHI subjects and considered to be the 'cardinal' cognitive-linguistic deficits following severe CHI were deficits in lexical-semantic and sentential semantic skills, verbal fluency, complex auditory comprehension, and attentional operations. Profile analysis revealed the existence of a double dissociation between performances on naming and verbal memory tasks and performances on visually related cognitive tasks. Results are discussed with reference to findings on previous studies of subgroups in the CHI population.

Social skill as determinant of social networks and perceived social support in schizophrenia.

Factors influencing supportive social networks of people with schizophrenia are little understood. Data from 46 outpatients with schizophrenia were analysed using structural equation modelling to test plausible sets of inter-relationships between social skill, social networks, and social support. The data supported a tentative model about the causal relationships between variables. Paths showed that people with greater social skill had larger social networks, but did not necessarily perceive greater support from these networks. Negative symptoms accounted for some of the effect of social skill on social networks. Whereas groups of single-admission and multiple-admission participants did not differ in terms of social skill, social networks, or support, the age of the participants influenced their social skill and the size of their social networks. Younger participants had greater social skill and larger social networks. The results appear to suggest the importance of early intervention for young people with first-episode psychosis.

Length of stay, leave and re-offending by patients from a Queensland security patients hospital.

OBJECTIVE: The release of patients from a security patients hospital has been the subject of public controversy. The present study uses empirical data to examine the length of stay, leave, and re-offending of patients from a security hospital. METHODS: Survival analysis was used to examine factors that may be predictive of length of stay and time under restriction, as well as time to first overnight leave. Data on re-offending were obtained from a variety of sources and were compared with seriousness of index offences. RESULTS: Consistent with international research, patients with more serious offences had longer hospitalisations. Patients with more serious offences were also hospitalised for longer periods before leave was granted. Compared with international studies, re-offending was in the lower range. CONCLUSIONS: Despite concerns raised in the media regarding patient 'dangerousness', time spent in hospital and the granting of leave, patients with serious offences were more likely to be hospitalised longer, which suggests decision makers do take into account public safety.

Models of alcohol use by young adults: an examination of various attitude-behavior theories.

OBJECTIVE: The aim of this study was to test the effectiveness of various attitude-behavior theories in explaining alcohol use among young adults. The theory of reasoned action (TRA), the theory of planned behavior and an extension of the TRA that incorporates past behavior were compared by the method of maximum-likelihood estimation, as implemented in LISREL for Windows 8.12. METHOD: Respondents consisted of 122 university students (82 female) who were questioned about their attitudes, subjective norms, perceived behavioral control, past behavior and intentions relating to drinking behavior. Students received course credit for their participation in the research. RESULTS: Overall, the results suggest that the extension of the theory of reasoned action which incorporates past behavior provides the best fit to the data. For these young adults, their intentions to drink alcohol were predicted by their past behavior as well as their perceptions of what important others think they should do (subjective norm). CONCLUSIONS: The main conclusions drawn from the research concern the importance of focusing on normative influences and past behavior in explaining young adult alcohol use. Issues regarding the relative merit of various alternative models and the need for greater clarity in the measure of attitudes are also discussed.

Subject-based problem-based learning in the veterinary science course at the University of Queensland.

OBJECTIVE: To assess students' perceptions of subject-based problem-based learning in the fourth year of the veterinary science course at the University of Queensland. DESIGN: A questionnaire-based study. PROCEDURE: Subject-based problem-based learning was introduced into parts of two fourth year subjects in a 5-year veterinary science course. The problem-based learning exercise used modified clinical cases and was computer-assisted. Students worked in groups of two to four, and small group discussion sessions were tutorless. Lectures were replaced by large group discussion and feedback sessions, led by the teacher, with approximately 85 students. RESULTS: There was a significant increase in the percentage of students who strongly agreed that they had better understanding of the subject, and had learned to apply principles from this class in new situations. The only consistent criticism by students was directed at the extra time required compared to traditional lecture-based subjects. CONCLUSION: Students' perceptions of the learning outcome were very favourable for problem-based learning when compared to the lecture-based subject.

Superovulation and intrauterine insemination vs. superovulation alone in the treatment of unexplained infertility. A randomized study.

OBJECTIVE: To assess whether intrauterine insemination (IUI) improves the fertility rates in women with unexplained infertility. STUDY DESIGN: We recruited 68 women with unexplained infertility and allocated them randomly to treatment with three to five cycles of superovulation plus IUI (36 patients) or superovulation alone (32 patients). Superovulation was obtained with clomiphene citrate, human menopausal gonadotropins and human chorionic gonadotropins. RESULTS: The cycle fecundity rate was 10% in patients who underwent superovulation alone and 19% in those treated with superovulation plus IUI (P < .05). CONCLUSION: Our results demonstrate that superovulation plus IUI is more effective than superovulation alone in the treatment of unexplained infertility.

Team managed outpatient care for early onset chronic inflammatory arthritis.

OBJECTIVE: To determine whether an outpatient team management program for persons with early chronic inflammatory arthritis would produce improved clinical outcomes and lower costs than traditional, nonteam outpatient rheumatologic care in a clinic setting. METHODS: One hundred eighteen patients with chronic inflammatory arthritis were randomly assigned to a team managed outpatient care program (TEAMCARE) or to traditional, one on one, nonteam managed rheumatologic care (TRADCARE). The TEAMCARE program consisted of a half day educational program, a needs assessment intake interview, and quarterly telephone calls, monthly team meetings, and routine rheumatologic care. TRADCARE patient received unconstrained, routine primary and specialty outpatient care as practised typically by rheumatologists at this large multi-specialty clinic. All patients had numerous physical and laboratory outcome assessments by rheumatologists at office visit. Every 6 months, patients completed several self-report measures of functional status, pain, psychosocial status, and costs. RESULTS: One hundred seven patients completed one year of study participation. No significant differences were found between groups in measures of physical status, physical functioning, psychosocial status, or pain. There were no differences between groups in economic or utilization measures. CONCLUSION: This team managed outpatient program for persons with recent onset chronic inflammatory arthritis afforded no advantage to routine outpatient care, characterized mainly by one on one relationships between patients and primary care doctors and rheumatologists, in our active outpatient clinical environment.