44 research outputs found
Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit
Get PDFBlood lead level and dental caries in school-age children.
Get PDFThe association between blood lead level and dental caries was evaluated in cross-sectional analyses of baseline data for 543 children 6-10 years old screened for enrollment in the Children's Amalgam Trial, a study designed to assess potential health effects of mercury in silver fillings. Approximately half of the children were recruited from an urban setting (Boston/Cambridge, MA, USA) and approximately half from a rural setting (Farmington, ME, USA). Mean blood lead level was significantly greater among the urban subgroup, as was the mean number of carious tooth surfaces. Blood lead level was positively associated with number of caries among urban children, even with adjustment for demographic and maternal factors and child dental practices. This association was stronger in primary than in permanent dentition and stronger for occlusal, lingual, and buccal tooth surfaces than for mesial or distal surfaces. In general, blood lead was not associated with caries in the rural subgroup. The difference between the strength of the associations in the urban and rural settings might reflect the presence of residual confounding in the former setting, the presence of greater variability in the latter setting in terms of important caries risk factors (e.g., fluoride exposure), or greater exposure misclassification in the rural setting. These findings add to the evidence supporting a weak association between children's lead exposure and caries prevalence. A biologic mechanism for lead cariogenicity has not been identified, however. Our data are also consistent with residual confounding by factors associated with both elevated lead exposure and dental caries
Cancer control needs of 2-1-1 callers in Missouri, North Carolina, Texas, and Washington
Get PDFInnovative interventions are needed to connect underserved populations to cancer control services. With data from Missouri, North Carolina, Texas, and Washington this study a) estimated the cancer control needs of callers to 2-1-1, an information and referral system used by underserved populations, b) compared rates of need to state and national data, and c) examined receptiveness to needed referrals. From October 2009 to March 2010 callers’ (N = 1408) cancer control needs were assessed in six areas: breast, cervical, and colorectal cancer screening, HPV vaccination, smoking, and smoke-free homes using Behavioral Risk Factor Surveillance System (BRFSS) survey items. Standardized estimates were compared to state and national rates. Nearly 70% of the sample had at least one cancer control need. Needs were greater for 2-1-1 callers compared to state and national rates, and callers were receptive to referrals. 2-1-1 could potentially be a key partner in efforts to reduce cancer disparities
<html>Cancer Control Needs of <i>2-1-1</i> Callers in Missouri, North Carolina, Texas, and Washington</html>
Get PDFInnovative interventions are needed to connect underserved populations to cancer control services. With data from Missouri, North Carolina, Texas, and Washington this study a) estimated the cancer control needs of callers to 2-1-1, an information and referral system used by underserved populations, b) compared rates of need to state and national data, and c) examined receptiveness to needed referrals. From October 2009 to March 2010 callers’ (N = 1408) cancer control needs were assessed in six areas: breast, cervical, and colorectal cancer screening, HPV vaccination, smoking, and smoke-free homes using Behavioral Risk Factor Surveillance System (BRFSS) survey items. Standardized estimates were compared to state and national rates. Nearly 70% of the sample had at least one cancer control need. Needs were greater for 2-1-1 callers compared to state and national rates, and callers were receptive to referrals. 2-1-1 could potentially be a key partner in efforts to reduce cancer disparities
Physicians and Duty During a Pandemic: A Response
No full textAfter reading Dr. Alpert\u27s commentary, we suspect art inspires life but not consistently with historical fact. Duty to serve, a hallmark of professional medicine, is not always exhibited during pandemics. The perception is that physicians provided care to others without personal regard in pandemics. Yet, Camus\u27s physician did not view himself as heroic. Rieux stated “there is no question of heroism in all this. It\u27s a matter of common decency” and it was about “giving people a chance,” trying to alleviate suffering (p. 278).
Since the mid-1980s, medical historians have accepted the Zuger-Miles hypothesis, arguing there was no “strong or constant” tradition of physicians rendering care in epidemics because of a sense of professional responsibility. Most physicians treated patients who sought help often at great cost and personal risk. Other physicians fled in time of plague. During yellow fever and cholera outbreaks, physicians refused to visit patients who were acutely ill. Overtreatment with dangerous and ineffective therapies was worse than abandonment. Some physicians acted on the basis of monetary or contractual agreements. Other physicians became itinerant: “frequently bills were set up upon their doors and written, ‘here is a doctor to be let’ . . . several of those physicians were fain for a while to sit still and look about them, or . . . remove their dwellings, and set up in a new place and among new acquaintance” (p. 361).
Modern debate over physician duty occurred during the century-old Spanish influenza pandemic wherein more than 600 US civilian physicians died. Recent concerns about duty have occurred during the HIV, SARS, Ebola, and current COVID19 outbreak. Hundreds of health care workers in West Africa died during the Ebola outbreak, and numerous health care workers have succumbed during the current pandemic.
Even with social and organizational changes in modern medicine, with conflicting duties and roles for physicians in complex economic and contractual settings, the Zuger-Miles hypothesis is confirmed. We were heartened by selfless efforts of house staff in the current pandemic, placing patient care and duty above personal and family obligations. We witnessed fear of contagion among providers—translated into refusal to provide care but also translated into significant morbidity and mortality for providers. Colleagues reported feeling sidelined; physicians wanted to do more. We heard concerns regarding institutional exploitation: the duty to do more. Physician duty and obligations toward patients should not be exploited, placing physicians at risk and in circumstances considered morally, psychologically, or physically unacceptable. Our observations confirm that duty during pandemics is not a heroic, dichotomous, individual choice but rather a complex, nuanced decision, influenced by conflicting, competing, and overlapping goals, moral obligations, and institutional and contractual concerns.
Camus\u27s Plague reminds physicians that dead rats are everywhere—epidemics, wars, and natural disasters—creating refugees, illness, and untold human suffering. Despite social, political, and scientific progress, these threats persist and repeat. Camus\u27s physician protagonist compiles his chronicle so that he can “bear witness in favor of those plague-stricken people; so that some memorial of the injustice and outrage done them might endure; and to state quite simply what we learn in a time of pestilence” (p. 278). Camus\u27s protagonist continues to remind physicians of the duty to care for patients and of pandemic lessons from history.</p
A case of asymptomatic pancytopenia with clinical features of hemolysis as a presentation of pernicious anemia
No full textPernicious anemia is an autoimmune disease with a variety of clinical presentations. We describe a case of pernicious anemia presenting with pancytopenia with hemolytic features. Further workup revealed very low vitamin B12 levels and elevated methylmalonic acid. It is important for a general internist to identify pernicious anemia as one of the cause of pancytopenia and hemolytic anemia to avoid extensive workup. Pernicious anemia can present strictly with hematological abnormalities without neurological problems or vice versa as in our case
A case of asymptomatic pancytopenia with clinical features of hemolysis as a presentation of pernicious anemia
No full textPernicious anemia is an autoimmune disease with a variety of clinical presentations. We describe a case of pernicious anemia presenting with pancytopenia with hemolytic features. Further workup revealed very low vitamin B12 levels and elevated methylmalonic acid. It is important for a general internist to identify pernicious anemia as one of the cause of pancytopenia and hemolytic anemia to avoid extensive workup. Pernicious anemia can present strictly with hematological abnormalities without neurological problems or vice versa as in our case
