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Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditions that are four times more prevalent among children of color living in impoverished communities as compared to the general population. This disparity is largely due to the increased exposure to stressors related to low socioeconomic status including community violence, unstable housing, under supported schools, substance abuse, and limited support systems. However, despite high rates and greater need, there is a considerably lower rate of mental health service utilization among these youth. Accordingly, the current study aims to describe a unique model of integrated health care for ethnically diverse youth living in a New York City borough. With an emphasis on addressing possible barriers to implementation, integrated models for children have the potential to prevent ongoing mental health problems through early detection and intervention.

Background: A comprehensive look at health status in developmentally disabled populations shows poorer physical, oral, and vision health, and higher rates of heart disease and obesity. Generally, individuals with developmental disabilities have difficulty locating able providers, and face significant barriers in accessing health services. The health care system's failure to achieve effective collaboration between medical, mental health, and residential providers too often results in substandard care and poor outcomes for these populations., Methods: A creative partnership between two organizations in rural upstate New York, Ulster Green ARC and the Institute for Family Health, has made substantial inroads toward addressing this problem. The organizations have transformed a relationship borne of a financially failing health care model into a successful, comprehensive care network for a severely developmentally disabled population-based in a Federally Qualified Health Center., Conclusions: The success of this effort is largely owing to an innovative use of health information technology to share information.

Increasing interest has been shown in shared decision making (SDM) to improve mental health care communication between underserved immigrant minorities and their providers. Nonetheless, very little is known about this process. The following is a qualitative study of fifteen primary care providers at two Federally Qualified Health Centers in New York and their experience during depression treatment decision making. Respondents described a process characterized in between shared and paternalistic models of treatment decision making. Barriers to SDM included discordant models of illness, stigma, varying role expectations and decision readiness. Respondents reported strategies used to overcome barriers including understanding illness perceptions and the role of the community in the treatment process, dispelling stigma using cultural terms, orienting patients to treatment and remaining available regarding the treatment decision. Findings from this study have implications for planning SDM interventions to guide primary care providers through treatment engagement for depression.

Measuring efficiency is essential but purchasers and providers should treat the perverse incentives of the efficiency index with caution, warn John Appleby and Val Little.

This study reports on several classification issues utilizing the Children's Depression Inventory (CDI), the Child Behavior Checklist-Teacher Form (CBCL-T), and the Peer Nomination Inventory of Depression (PNID). The first sample contained 752 public school children in grades 5, 6, and 9. A second sample of 142 fifth-graders was included to have an additional PNID comparison group. Results revealed moderate correlations between the CDI and the CBCL-T and PNID. Use of multiple criteria for selecting children as depressed was discussed, and selection rates using multiple measures with either strict or lenient cutoff scores were given. Normative data on the PNID were evaluated, and it was suggested that norms for the PNID may not be generalizable to other samples. Finally, race and gender analyses showed that CDI scores for females were significantly higher than for males, whereas CDI scores for Hispanics were significantly higher than for non-Hispanic whites. However, Omega-squared analyses for these two variables showed this to be of little practical significance.

Seventeen women complaining of infertility (one with primary amenorrhoea, 14 with secondary amenorrhoea, and two with oligomenorrhoea) all had hyperprolactinaemia and were treated with clomiphene citrate and human chorionic gonadotrophin (HCG), and plasma oestradiol, FSH and LH levels were measured. Although adequate pre-ovulatory oestradiol levels were present, the surge of LH was absent until the injection of HCG after which all patients ovulated. There were 12 pregnancies in 9 patients resulting in 10 full-term livebirths, one premature livebirth and one continuing pregnancy. The relevance of these findings to the possible role of prolactin in amenorrhoea is discussed.

Sixty-two women with unexplained infertility were studied. Fifteen (group 1) had timed intrauterine insemination (IUI), 25 (group 2) were treated by Pergonal (Serono Laboratories, Ltd., Welwyn Garden City, England) superovulation, and 22 (group 3) underwent Pergonal superovulation combined with IUI. Where Pergonal treatment was followed by insemination, a significantly greater pregnancy rate per cycle (P less than 0.05) was achieved, whether this group of patients was compared with those treated by IUI alone or with those treated with Pergonal alone. Moreover, the pregnancy rate in group 3 was comparable to that reported following gamete intrafallopian transfer (GIFT). The authors therefore suggest this form of treatment for patients with unexplained infertility prior to their referral to the more invasive procedure of GIFT.

The NORC happiness scale, widely used in Administration on Aging (A.O.A.) needs assessment surveys, is a composite of both a negative and a positive dimension. A re-examination of this scale based on a survey of 1400 urban and nonurban elderly indicates that the independence of these two dimensions varies for different residences. Results indicate that a high proportion of urban elderly were bored, depressed, and lonely as well as pleased, proud, excited, and interested in things about them. This group of urban elders was extremely disadvantaged in a wide range of both objective and subjective indices; their apparent inconsistent feeling states may result from a general feeling of relative deprivation.

Forty preterm infants with maternal isoxsuprine exposure less than 24 hours delivery and 40 matched control infants were studied prospectively to determine the acute neonatal effects of maternal ISX exposure. The cord ISX concentration correlated inversely with the drug-free interval before delivery (P < 0.001). Cord ISX concentrations > 10 mg/ml were seen only with intravenous maternal therapy and a drug-discontinuance to delivery interval of two hours or less. The plasma half-life of ISX in neonates ranged from 1.7 to 8 hours; gestationally younger infants required a longer time for drug clearance. Ileus was 13 times more common in the ISX group and was not directly related to the cord ISX concentration. The incidence of hypotension and hypocalcemia rose directly with the cord ISX concentration, reaching 89% and 100%, respectively, when the cord ISX level exceeded 10 ng/ml. The incidence of respiratory distress syndrome was low in the ISX infants with low cord drug values, but increased to that of the control group when the cord ISX concentration reached > 10 ng/ml.

Clomiphene citrate (Clomid), when given alone, is generally considered ineffective in inducing ovulation in women with hyperprolactinemia. This study reports the treatment of 29 infertile women with hyperprolactinemic amenorrhea. Twenty-one patients (eighteen of whom had previously had no ovulation response to Clomid alone) were treated with a combined regimen of Clomid (100 to 200 mg/day for 5 days) and two injections of 5000 IU of human chorionic gonadotropin (HCG), the first 8 to 10 days after Clomid withdrawal and a second injection 1 week later. Basal body temperature charts, conception, and/or plasma progesterone measurements showed that 19 patients ovulated (90%). There were 17 pregnancies in 12 of 21 patients (57% pregnancy rate) with 15 single live births and two abortions. When bromocriptine (Parlodel) became available, a total of 22 patients (including 14 patients previously treated with Clomid/HCG, six of them successfully) with amenorrhea associated with hyperprolactinemia were treated with this drug with dosages varying from 2.5 mg to 15 mg/day. Ovulation was confirmed in 20 patients (90%). There were 17 pregnancies in 15 patients (68% pregnancy rate) with 15 single live births and two first-trimester abortions. In all, 21 of 29 patients (73%) achieved one or more pregnancies resulting in live births with one or both of the above treatments. It is concluded that a combined Clomid/HCG regimen can often be used as an effective alternative to bromocriptine therapy in the treatment of infertility associated with hyperprolactinemic amenorrhea.

The previously reported relationship between internal locus of control and academic achievement was explored with the Nowicki-Strickland Locus of Control Scale for Children (Nowicki & Strickland, 1973) and seven measures of academic achievement in a random sample of 45 male residents of seven state learning centers for juvenile delinquents. Correlations between overall locus of control scores and all seven measures were significant, but with intelligence controlled in a partial correlation, locus of control scores were found to add little to the prediction of academic achievement from IQ scores alone. Discussion addressed possible explanations for the current findings in terms of the meaning of the scale for a nonnormal group and the effects of situations on responses of subjects.

Thirty patients with mild post-pubertal adrenal hyperplasia, characterized by raised urinary 17-oxosteroid levels and variable combinations of irregular menses, hirsuties, infertility, and spontaneous abortion, were treated with 2.5 to 10 mg of prednisone per day and all conceived (55 pregnancies). With this treatment, regular, ovulatory cycles occurred immediately in 25 patients, and after two to six months, in the rest. Treatment reduced raised 17-oxosteroid levels to normal and brought about some improvement in hirsuties and acne. Forty-seven pregnancies ended in the birth of liveborn infants; one of these died of prematurity and another had congenital emphysema. One pregnancy was terminated, two were of unknown outcome and five (9.4%) ended in abortion. Before treatment, 20 out of 22 pregnancies (91%) had ended in abortion.

Need is a multi-faceted, multi-dimensional concept. National and international efforts to assess the needs of the elderly confront common problems: lack of an accepted definition of terms such as "needs," "want" and "demand;" perceptions which vary with age, professional role, relationship and time; a range of methodologies encompassing rational, empirical and relativistic approaches, as well as subjective, objective and statistical measures. Research instruments are being refined and shared, but the state of the art remains in its infancy. Use of index of incapacity measures appears to offer the best data base for planning needed services.

Seventy patients treated with isoxsuprine for premature labor were studied. In patients with intact membranes prolongation of pregnancy for more than 7 days occurred in 77% of women with 50% cervical effacement or less and 3 cm dilatation or less at the initiation of therapy, and in none with more than 50% effacement and more than 3 cm dilatation. Cervical effacement was the primary factor in determining success. Cord isoxsuprine concentrations averaged 90% of maternal concentrations at delivery. Maternal and cord isoxsuprine concentrations at delivery were inversely correlated with the drug-free interval before delivery. An interval of more than 5 hours was necessary to attain a cord concentration of less than 2 ng/ml, a level not associated with neonatal problems. Drug-free intervals of 2 hours or less usually resulted in cord isoxsuprine values of more than 10 ng/ml, levels that are associated with severe neonatal problems. Seventy-seven percent of infants with cord isoxsuprine concentrations of more than 2 ng/ml and 91% with values of more than 10 ng/ml were delivered of mothers with more than 3 cm dilatation or more than 50% effacement at the initiation or reinstitution of intravenous therapy. Most severe neonatal problems are preventable if patients are selected carefully.

Many countries view the Swedish model of open care for the aged with increasing interest. Open care offers several points of access to the service system and a wide range of services both in urban and rural areas. Nevertheless, governments need more data for a comprehensive evaluation of cost-effectiveness and the degree of coordination between health and medical services and social and environmental services in comparison with other models of care.

If left undetected and untreated in the operating room, air embolism can be a potentially lethal event. It is important to be aware of the specific positions and surgical procedures that put a patient at risk for air emboli. This article will define air embolism, discuss its occurrence and effects on the body, review specific monitoring techniques used to detect intravascular air, and present techniques used for prevention and treatment by the operating room staff.

The effects on the neonate of severe maternal hypertension originating before the thirty-sixth week of gestation were determined by comparing data obtained on 28 preterm infants born of hypertensive mothers with data from 28 gestational age-matched controls. All hypertensive mothers had diastolic blood pressure greater than or equal to 110 mm Hg, proteinuria, and systemic symptoms of their disease; over half had thrombocytopenia and significant elevations of LDH and SGOT. All hypertensive mothers had been treated intravenously with magnesium sulfate, and 79% received other antihypertensive agents. When compared to control infants, the infants of hypertensive mothers had a significantly higher incidence of somatic growth retardation, microcephaly, thrombocytopenia, leukopenia, neutropenia, low Apgar scores, delayed adaptation, patent ductus arteriosus, hypotonia, and gastrointestinal hypomotility. Apgar scores, platelet count, WBC count, neutrophil count, and weight percentile correlated with the severity of maternal platelet and enzyme abnormalities. The occurrence of gastrointestinal hypomotility, hypotonia, and patent ductus arteriosus may be related to transplacental passage of maternally administered drugs.