RESUMEN

OBJECTIVES: This study described epidemiologic patterns of recreational injuries among school aged children in the US and assessed the relation of these patterns to socioeconomic status. METHODS: Combined data from the 1997-98 National Health Interview Surveys for 38 458 children aged 6-17 years regarding non-fatal recreational injury episodes that received medical attention, reported by a household adult, were analysed. Logistic regression analysis was used to assess the association between recreational injury and socioeconomic status while controlling for confounding factors. RESULTS: The annualized rate of recreational injury was 91.2 episodes per 1,000 children, with an increased risk associated with a higher family income status or being non-Hispanic white. For children from not poor families, most injury episodes occurred in sport facilities, whereas for children from poor and near poor families, most occurred outside the home. CONCLUSION: Recreational injury is a significant health problem for school aged children in the US. Non-Hispanic white children and children from affluent families are at increased risk of recreational injury.

Asunto(s)

RESUMEN

Awareness of AIDS among cocaine and crack users has never been studied using national data representative of the U.S. household population. Data from the 1991 National Health Interview Survey were analyzed. Respondents who reported cocaine (n = 448) or crack use (n = 100) in the past year were compared with those who reported never using any form of cocaine (n = 17,259). AIDS knowledge, HIV testing, risk behavior, and perceived risk for HIV were outcomes studied. Over 96% of the drug users know the term HIV compared with 89% of the nonusers. A higher proportion of cocaine users reorganized the effectiveness of condoms compared with nonusers (93% vs. 84%). Over 96% of all groups knew the risk of sharing needles. Cocaine and crack users were more likely to have been tested for HIV (27% and 28%) compared with nonusers (19%), yet less than one third of those tested actually received HIV counseling. High-risk behavior was acknowledged by 22% of cocaine users and 33% of crack users. However, only 10% and 14% respectively considered themselves to be at increased risk for having or getting HIV. These data suggest that cocaine and crack users are knowledgeable regarding HIV/AIDS, however they are underestimating their real risk of infection with HIV.

Asunto(s)

RESUMEN

OBJECTIVES: To describe the development of a pediatric quality of care measurement system designed to cover multiple clinical topics that could be applied to enrollees in managed care organizations and to compare the development of this system with the concurrent development of a similar system for adult women. DESIGN: Indicators were developed for 21 pediatric (ages 0-18 years) clinical topics and 20 adult (ages 17-50 years) women's clinical topics. Indicators were classified by the strength of evidence supporting them. A modified Delphi method was used to obtain validity and feasibility ratings from a pediatric expert panel and an adult women's expert panel. Indicators were categorized by type of care (preventive, acute, or chronic), function (screening, diagnosis, treatment, or follow up), and modality (history, physical examination, laboratory/radiology study, medication, other intervention, or other contact). RESULTS: Of 557 pediatric and 391 adult women's proposed indicators, 453 (81%) and 340 (87%), respectively, were retained by the 2 expert panels. A lower percentage of final pediatric indicators than adult indicators were based on randomized, controlled trials and other rigorous studies (18% vs 40%, P < .001). The expert panels were more likely to retain indicators based on rigorous studies (93% retained) than on descriptive studies and expert opinion (81% retained, P < .001). A higher percentage of pediatric indicators than women's indicators were for preventive care (30% vs 11%, P < .001) and a lower percentage were for acute care (36% vs 49%, P < .001) or chronic care (34% vs 41%, P = .06). CONCLUSIONS: This study contributes to the field of pediatric quality of care assessment by providing many more indicators than have been available previously and by documenting the strength of evidence supporting these indicators. Formal consensus methods are essential for the development of pediatric quality measures because the evidence base for pediatric care is more limited than for adult care.

Asunto(s)

RESUMEN

L-701,324 (7-chloro-4-hydroxy-3-(3-phenoxy) phenyl-2-(1H)-quinolone) is a novel, orally active antagonist at the N-methyl-D-aspartate (NMDA) receptor glycine site. As NMDA receptor antagonism is generally associated with anaesthetic effects, we have examined the electroencephalographic alterations produced by doses of L-701,324 that effectively reduce NMDA-evoked responses in vivo. Microdialysis probes incorporating an electrode were implanted in the striatum of rats and perfused with artificial cerebrospinal fluid (ACSF). Under light halothane anaesthesia, 12 consecutive depolarizations were elicited by switching to ACSF containing 200 microM NMDA for 2 or 3 min, every 20 min. NMDA-evoked depolarizations and EEG were recorded with the microdialysis electrode. L-701,324 (5 or 10 mg kg-1 i.v.) or vehicle were administered 5 min after the 3rd NMDA stimulus. L-701,324 dose-dependently inhibited NMDA-evoked depolarizations, with 10 mg kg-1 reducing these responses by 50% for at least 3 h. The average amplitude of the EEG in the window 0.25-6 Hz (low frequencies) and 6-21 Hz (high frequencies) did not change in the control group. At the higher dose of 10 mg kg-1 L-701,324 transiently increased the amplitude of low frequencies by around 20%. In contrast, both 5 and 10 mg kg-1 significantly reduced the high frequencies to around 70% of control, and this action was sustained with the higher dose. Analysis of the relative EEG power spectra confirmed a small, but persistent shift from high to low EEG frequencies. Our results suggest that L-701,324 slightly strengthened halothane anaesthesia at doses inhibiting effectively NMDA receptor function. Accordingly, the resulting anticonvulsant and neuroprotective actions of L-701,324 may not be associated with marked anaesthesia-like side-effects.

Asunto(s)

RESUMEN

As N-methyl-D-aspartate receptor (NMDA) ionophore complexes have a distinct positive, allosteric regulatory site for glycine, it has been proposed that elevated extracellular glycine during or after cerebral ischaemia may induce excessive NMDA/glutamate receptor activation and, thereby, excitotoxicity. To test this hypothesis, we have perfused increasing concentrations of glycine, either alone or with co-application of NMDA, through a microdialysis probe implanted in the striatum of halothane anaesthetized rats. Changes in the extracellular field (DC) potential indicative of depolarization were recorded precisely at the site of drug application by an electrode incorporated within dialysis fibre. Microdialysis application of up to 1 mM of glycine had no effect on the basal DC potential. Above 10 mM, glycine produced concentration-dependent depolarizations, but the amplitude of these responses remained very small (e.g. 0.52 +/- 0.05 mV for 100 mM glycine, n = 10, i.e. around 30-fold smaller than that of a wave of spreading depression). Application of 200 microM NMDA via the microdialysis probe produced consistent short-lasting depolarizations (around 2.5 mV amplitude), but these were not potentiated by co-application of up to 100 mM glycine. These data do not support the view that increased extracellular concentrations of glycine, such as those observed in ischaemia, may be potentially excitotoxic. Nevertheless, as occupation of the glycine site coupled to the NMDA-receptor is required for NMDA/glutamate receptor activation, this site remains an attractive target for potential neuroprotective agents.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

The time course of changes in extracellular glutamic acid levels and their Ca2+ dependency were studied in the rat striatum during focal cerebral ischaemia, using microdialysis. Ischaemia-induced changes were compared with those produced by high K(+)-evoked local depolarization. To optimize time resolution, glutamate was analysed continuously as the dialysate emerged from the microdialysis probe by either enzyme fluorimetry or biosensor. The Ca2+ dependency of glutamate changes was examined by perfusing the probe with Ca(2+)-free medium. With normal artificial CSF, ischaemia produced a biphasic increase in extracellular glutamate, which started from the onset of ischaemia. During the first phase lasting approximately 10 min, dialysate glutamate level increased from 5.8 +/- 0.9 microM.min-1 to 35.8 +/- 6.2 microM where it stabilized for approximately 3 min. During the second phase dialysate glutamate increased progressively to its maximum (82 +/- 8 microM), reached after 55 min of ischaemia, where it remained for as long as it was recorded (3 h). The overall changes in extracellular glutamate were similar when Ca2+ was omitted from the perfusion medium, except that the first phase was no longer detectable and, early in ischaemia, extracellular glutamate increased at a significantly slower rate than in the control group (2.2 +/- 1 microM.min-1; p < 0.05). On the basis of these data, we propose that most of the glutamate released in the extracellular space in severe ischaemia is of metabolic origin, probably originating from both neurons and glia, and caused by altered glutamate uptake mechanisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Asunto(s)

RESUMEN

In 1992, levels of knowledge about the major modes of human immunodeficiency (HIV) transmission remained high in all sociodemographic groups examined. Knowledge about other aspects of acquired immunodeficiency syndrome (AIDS) was more variable with older and less educated adults generally being less knowledgeable. Changes in knowledge between 1991 and 1992 included: An increase from 86 to 95 percent in the proportion who had heard the AIDS virus referred to as "HIV" An increase from 15 to 22 percent in the proportion of young adults (18-29 years of age) who planned to be tested in the next year An increase from 13 to 17 percent in the proportion of adults who had a coworker, relative, or friend with AIDS An increase from 69 to 75 percent in the proportion of parents of 10-17-year-olds who had ever discussed AIDS with their children.

Asunto(s)

RESUMEN

OBJECTIVES: The purpose of this study was to assess the association between child care arrangements and repeated ear infections in young children. METHODS: Data on 5818 children younger than 6 years of age were taken from the 1988 National Health Interview Survey of Child Health. RESULTS: Seventeen percent of the children had had repeated ear infections in the year preceding the interview. Multiple logistic regression analysis showed that factors significantly associated with repeated ear infections were age (1 to 2 years), race (White), sex (male), and medical history (repeated tonsillitis, enlarged adenoids, or asthma). When these factors were controlled for, children in a current child care arrangement still had a 50% higher chance of repeated ear infections than did children not in care. Children in day care centers were at higher risk than children cared for in homes. Care in settings with more than six children elevated the risk, but hours per week of care did not. CONCLUSIONS: Decreasing the risk of repeated ear infections in young children in out-of-home child care settings may require smaller group sizes. Given the increasing use of child care, research should continue to identify specific aspects of child care that contribute to this problem.

Asunto(s)

Asunto(s)

RESUMEN

To see how successful human immunodeficiency virus (HIV) counseling and testing efforts have been in testing the United States population, particularly among those at increased risk for HIV infection, we analyzed data from the 1989 National Health Interview Survey. Twenty percent of the NHIS sample (or, in terms of the general US population, an estimated 36 million persons) reported having been tested for HIV antibodies, mostly through blood donations. Although persons with increased risk of HIV infection had been tested and counseled at a much higher rate than the general population, the majority of this group had not yet been tested.

Asunto(s)

Asunto(s)

RESUMEN

Increasing awareness about AIDS is an important step toward the prevention of this disease. The AIDS Knowledge and Attitudes Survey of the National Health Interview Survey shows that more than 80 percent of U.S. adults are familiar with the major modes of AIDS transmission. Despite this, up to one-third still believe that AIDS can be spread by various forms of casual contact. In the three racial/ethnic groups studied, the less educated were less knowledgeable. Further, black and Hispanic adults lagged somewhat behind white adults in certain important aspects of AIDS knowledge. About one-fourth of white, black and Hispanic adults have had the HIV antibody test. While reasons for testing differed, most of the adults were tested in health care sites. Educational counseling that should accompany HIV testing is provided to less than half of those tested. Identifying gaps in knowledge can help to more effectively target AIDS educational efforts.

Asunto(s)

RESUMEN

We conducted a study to assess the level of AIDS knowledge, testing behavior patterns, and self-assessed risk of contracting AIDS for a representative sample of health care workers in the United States. The study was based on data collected in the 1989 AIDS Knowledge and Attitudes Supplement to the National Health Interview Survey. Health care workers in four occupational groups were compared with other members of the labor force and with one another. The survey included 1,620 respondents identified as health care workers and 25,217 respondents with occupations other than in health care. Health care workers were more knowledgeable about AIDS than were other workers; approximately 55% and 25%, respectively, reported knowing a lot about AIDS. They were also more likely to have been tested (34%) than other workers (24%) and to have done so voluntarily (28% versus 14%). Health care workers also believed they had higher risk of contracting AIDS (8% versus 3%), although they were about equally likely to report being in one of the six high-risk groups. Among health care workers, those in the health diagnosing occupations were the most knowledgeable about AIDS (74% reported knowing a lot) and were the most likely to have been tested (41% were tested at least once). Health service workers were the least knowledgeable; only 38% reported knowing a lot about AIDS and only 26% reported being tested.

Asunto(s)

RESUMEN

BACKGROUND: Accurate information about acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) is important for prevention. This study determined whether AIDS knowledge varied among populations residing in areas with a low, medium, or high incidence of AIDS. METHODS: Respondents to the 1988 National Health Interview Survey of AIDS Knowledge and Attitudes, which is based on a nationally representative sample of 29,659 adults, were rated on their knowledge about modes of HIV transmission, general knowledge about AIDS, and misperceptions about HIV transmission through casual contact. RESULTS: Persons 50 years of age or older, Blacks, Hispanics, and persons with less than a high school education had lower knowledge scores and higher misperception scores. Residents of the high-incidence area had more misperceptions than those who lived in the medium- or low-incidence areas. Sociodemographic determinants of scores were important factors overall and within each AIDS incidence area. CONCLUSIONS: These data suggest that the ability of educational messages to reach and be absorbed by individuals nationwide is less dependent on whether they live in an area with a high incidence of AIDS and more dependent on other demographic variables. New and continued efforts are needed to improve knowledge in older persons, minorities, and the less educated in all parts of the country.

Asunto(s)

RESUMEN

This report provides estimates of the lifetime and annual incidence of selected infectious diseases for children in various demographic groups. The social and health care impact of these diseases in terms of limitation in activity, bed days, school days lost, physician contacts, hospitalizations, surgery, and use of medication is also presented. The data are from the 1988 National Health Interview Survey on Child Health.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)