ABSTRACT
Small-bowel obstruction is an old and common problem. Like most illnesses, its diagnosis and treatment continue to evolve. The radiologic approach to the investigation of small-bowel obstruction and the timing of surgical intervention have undergone considerable changes during the past decade. In this review, the authors analyze the recently described radiologic techniques used in the examination of patients with suspected mechanical small-bowel obstruction, revisit the controversy of the short versus long decompression tube, and provide insights on how to optimize the radiologic investigation and nonsurgical management of small-bowel obstruction.
Subject(s)
Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/therapy , Algorithms , Equipment Design , Humans , Intestinal Obstruction/physiopathology , Intestine, Small , Intubation/instrumentation , Patient Selection , RadiographyABSTRACT
BACKGROUND: The purpose is to determine the administrative validity of the 4-3-1 immunization rates for DPT-OPV-MMR vaccines for 2-year-old children in a community health status assessment project by accounting for premature administration of specific vaccine doses according to ACIP recommended minimal timing intervals. METHODS: A retrospective survey of immunization certificates was made on a random sample of 1,059 kindergarten enrollees in the county, including public, private, and parochial schools. The immunization rates by the crude 4-3-1 counting method were compared with the same method adjusted for minimal time interval vaccine dosing. RESULTS: By the crude 4-3-1 counting method, 55.5% of the students had complete immunizations by their second birthdate, and 11.8% did not meet the minimum interval recommendations on at least one of 4-3-1 vaccine series. The adjustment for minimum time interval reduced the percent in compliance with the 4-3-1 counting method by age 2 in the community to 50.7%. CONCLUSION: The premature timing of vaccine doses is a threat to the validity of the 4-3-1 counting method. The crude 4-3-1 method over-estimates the completed immunization rates for 2-year-olds in this community-based study by about 4.8%.
Subject(s)
Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage , Immunization Schedule , Measles Vaccine/administration & dosage , Mumps Vaccine/administration & dosage , Poliovirus Vaccine, Oral/administration & dosage , Rubella Vaccine/administration & dosage , Vaccination/statistics & numerical data , Child, Preschool , Data Collection , Evaluation Studies as Topic , Female , Humans , Kentucky , Male , Measles-Mumps-Rubella Vaccine , Retrospective Studies , Sampling Studies , Sensitivity and Specificity , Time Factors , Vaccines, Combined/administration & dosageABSTRACT
BACKGROUND: Depression is a significant health problem in the United States. This study examined the relationship between depression and substance use, substance problems, conduct disorders, and sociodemographic factors in primary care settings. METHODS: A survey of 1898 patients in 88 primary care offices was conducted using a self-administered health-habits questionnaire. Depression was assessed for both lifetime and for the past 30 days using the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R) criteria. RESULTS: A total of 21.7% of women and 12.7% of men met DSM-III-R criteria for depression in the 30 days prior to completing the survey. Lifetime rates of depression were 36.1% for women and 23.3% for men. Young women who smoke, drink, or use marijuana, and both men and women with antisocial personality disorder and a family history of mental health problems are particularly at high risk for depression. CONCLUSIONS: One in 5 women and one in 10 men who see their primary care physicians have recently been depressed.
