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Antonucci JV, Martin ES, Hulick PJ, Joseph A, Martin SE. Bernard-Soulier syndrome: common ancestry in two African American families with the GP Ib alpha Leu129Pro mutation. Am J Hematol 2000; 65:141-8. [PMID: 10996832 DOI: 10.1002/1096-8652(200010)65:2<141::aid-ajh9>3.0.co;2-h] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Bernard-Soulier syndrome (BSs) is a rare bleeding disorder characterized by circulating giant platelets, thrombocytopenia, and a prolonged bleeding time. BSs usually has an autosomal recessive inheritance pattern, with a preponderance of Caucasian and Japanese ancestry when the ethnic background has been reported. Underlying this disorder of platelet function is a defect in the platelet glycoprotein (GP) Ib-IX-V complex, composed of four polypeptides, GP Ib alpha, GP Ib beta, GP IX, and GP V. Molecular characterization of individuals with BSs has identified mutations in the GP Ib alpha, GP Ib beta, and GP IX genes responsible for the expressed phenotype. In this study, we report a family of African-American descent, with autosomal recessive BSs showing a point mutation in codon 129 of the GP Ib alpha gene. This mutation, CTC:wild-type to CCC:mutant, is similar to that of another African American family where the resulting leucine to proline substitution in the 5(th) leucine-rich repeat of GP Ib alpha is responsible for the observed BSs phenotype. Comparison of the intragenic polymorphisms of GP Ib alpha, as well as microsatellite markers in a 17.5 cM region of chromosome 17p12 that contains the GP Ib alpha gene, suggests that, although socially unrelated, the Leu129Pro mutation in these two families has a common founder.
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Haq C, Rothenberg D, Gjerde C, Bobula J, Wilson C, Bickley L, Cardelle A, Joseph A. New world views: preparing physicians in training for global health work. Fam Med 2000; 32:566-72. [PMID: 11002868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND OBJECTIVES To determine the impact of international health experiences on physicians in training, we studied 60 US medical students who participated in an International Health Fellowship Program (IHFP). METHODS In 1995 and 1996, US medical students were selected to participate in the IHFP, which included training at three US medical schools and at seven medical schools in developing countries. The program included a 2-week preparatory course at a US school and a 6- to 8-week field experience. Evaluative data were collected prior to the course, after the course, after the field experience, and 1-2 years later. RESULTS A total of 60 students were selected from 145 applicants. At the end of the fellowship, a majority of participants noted that the exposure affected them in the following ways: changed world views; increased cultural sensitivity; enhanced community, social, and public health awareness; enhanced clinical and communication skills; more appropriate resource utilization; changes in career plans; and a greater understanding of the challenges of working in areas with scarce resources. After the international field experience, students more strongly agreed with the importance of oral rehydration, communication skills, and patient education. According to student self-assessments, the IHFP significantly improved core medical skills. Ninety-six percent of participants recommended international health experiences for other students. CONCLUSIONS This study of IHFP fellows demonstrates multiple significant impacts of international health experiences on US medical students in training. The knowledge, attitudes, and skills gained through international health experiences are important for medical practice in the United States and abroad. Given the high interest of medical students in international health and the potential for positive educational impacts, medical schools should increase the availability of high-quality international experiences.
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Abraham S, Prasad J, Joseph A, Jacob KS. Confidentiality, partner notification and HIV infection: issues related to community health programmes. THE NATIONAL MEDICAL JOURNAL OF INDIA 2000; 13:207-11. [PMID: 11002691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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156
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Graff L, Prete M, Werdmann M, Monico E, Smothers K, Krivenko C, Maag R, Joseph A. Implementing emergency department observation units within a multihospital network. THE JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT 2000; 26:421-7. [PMID: 10897459 DOI: 10.1016/s1070-3241(00)26035-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The proportion of emergency department (ED) chest pain patients who undergo an extended "rule out MI (myocardial infarction)" evaluation beyond the ED determines both the quality and cost of patient care. The higher an organization's rate of such evaluations, the lower the average miss rate for MI. Five of the 13 hospitals in the Voluntary Hospital Association Northeast multihospital network implemented ED observation units by June 1997 for outpatient rule out MI evaluations. RESULTS Compared with historical and case controls, the five hospitals with ED observation units had a higher observation rate (16% versus 0% [p < .001] and 2% [p < .001]) and a higher rule out MI evaluation rate (61% versus 46% [p < .01] and 45% [p < .01]), without a significantly higher admission rate (47% versus 46% and 45%). For the three hospitals with observation units that collected charge data during 1997 on a consecutive series of chest pain patients who had negative rule out MI evaluations, charges for patient services were lower for patients evaluated in the ED observation unit ($2,214.80 +/- $80.40) than in the hospital ($5,464.30 +/- $393.60). CONCLUSIONS ED observation units represent a cost-effective restructuring of the diagnostic approach to patients with acute chest pain. In an improvement of quality of patient care, a larger proportion of ED chest pain patients receive an extended evaluation than is possible with hospital admission as the only ED disposition option.
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Elpeleg ON, Shaag A, Glustein JZ, Anikster Y, Joseph A, Saada A. Lipoamide dehydrogenase deficiency in Ashkenazi Jews: an insertion mutation in the mitochondrial leader sequence. Hum Mutat 2000; 10:256-7. [PMID: 9298831 DOI: 10.1002/(sici)1098-1004(1997)10:3<256::aid-humu16>3.0.co;2-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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158
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Ramaiah KD, Radhamani MP, John KR, Evans DB, Guyatt H, Joseph A, Datta M, Vanamail P. The impact of lymphatic filariasis on labour inputs in southern India: results of a multi-site study. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2000; 94:353-64. [PMID: 10945045 DOI: 10.1080/00034983.2000.11813550] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A multi-site study was undertaken, in the rural areas of three districts in Tamil Nadu state, in southern India, to examine the impact of acute and chronic forms of lymphatic filariasis, caused by infection with Wuchereria bancrofti, on labour inputs. More than half of the acute episodes of adenolymphangitis (ADL) observed in the study communities caused total disability. The mean (S.D.) time that each ADL case was able to allocate to economic activity each day during these acute episodes was much less than seen in the controls matched for sex, age and occupation [0.97 (2.36) v. 4.48 (3.82) h; P < 0.01]. The acute disease also severely affected domestic activities, with female ADL cases spending only 1.54 (2.12) h/day on domestic activity, compared with 4.18 (2.61) h by controls. The subjects with chronic filariasis also spent significantly less time in economic activity than their matched controls [4.40 (3.79) v. 5.13 (3.83) h/day; P < 0.01). Although the acute episodes have a dramatic effect on the productivity of the affected individual, the labour loss caused by chronic disease is more serious, as the manifestations of chronic disease mostly affect the most productive age-groups, persist for life and are mostly irreversible. The adverse impact of acute and chronic filariasis was observed in males and females, farmers and non-farmers and during the rainy, winter and summer seasons. It is estimated that about 3.8% of the potential labour inputs of the men and 0.77% of those of the women were lost because of lymphatic filariasis. In addition to this loss, the total economic burden of the disease must include the costs of treatment and other health care and of the resources spent on control programmes. Estimates of the disease burden are likely to be useful in determining the costs and benefits of the recently launched campaign to eliminate lymphatic filariasis.
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Harris R, Joseph A. Spontaneous pneumomediastinum--'ectasy': a hard pill to swallow. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 2000; 30:401-3. [PMID: 10914764 DOI: 10.1111/j.1445-5994.2000.tb00848.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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160
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Sudhindra TV, Joseph A, Haray PN, Hacking BC. Are surgeons aware of the dangers of diathermy? Ann R Coll Surg Engl 2000; 82:189-90. [PMID: 10911759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Surgical diathermy is an invaluable aid in modern surgery and most contemporary diathermy machines are considered safe. However, diathermy accidents do still occur and a diathermy unit can be potentially lethal if adequate care is not exercised in its use.
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Pickett M, Bruner DW, Joseph A, Burggraf V. Prostate cancer elder alert. Living with treatment choices and outcomes. J Gerontol Nurs 2000; 26:22-34; quiz 54-5. [PMID: 10776173 DOI: 10.3928/0098-9134-20000201-11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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162
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Bruner DW, Pickett M, Joseph A, Burggraf V. Prostate cancer elder alert. Epidemiology, screening, and early detection. J Gerontol Nurs 2000; 26:6-15; quiz 54-5. [PMID: 10776164 DOI: 10.3928/0098-9134-20000101-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Tracheal laceration is a rare complication of endotracheal intubation. We present a case of tracheal laceration after a simple prehospital tracheal intubation in a patient with severe tracheomalacia. The most likely cause of the tracheal injury was massive overinflation of the endotracheal tube cuff and the preexisting tracheal wall weakness. The case illustrates the classic radiologic signs of tracheal laceration, and we review the relevant literature.
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Joseph A, Kutty VR, Soman CR. High risk for coronary heart disease in Thiruvananthapuram city: a study of serum lipids and other risk factors. Indian Heart J 2000; 52:29-35. [PMID: 10820930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
There is a trend towards increase in the incidence of coronary heart disease among Indian population. Also, little information is available on the population distribution of serum lipid components and risk factors for coronary heart disease in Kerala, a state fast turning urban. To study the serum lipid profile and the prevalence of other risk factors for coronary heart disease in the residents of an urban housing settlement in Thiruvananthapuram, fasting blood sample was collected from 206 (64%) residents above the age of 19 years and analysed for plasma glucose and various fractions of serum lipids. A detailed questionnaire on the clinical profile and history of the subjects, and measured weights and heights was also administered. Mean serum total cholesterol was 223.7 +/- 45.3 mg/dL; 223.7 +/- 44.9 mg/dL among males and 223.7 +/- 45.8 mg/dL among females. Mean high-density lipoprotein cholesterol was consistently higher in females in all age groups, while mean low-density lipoprotein cholesterol was higher in males till the age group 40-49 after which the pattern was reversed. Mean total cholesterol in the age range 35-64, after age standardisation, was 229.4 mg/dL. Mean serum total cholesterol was higher in this sample when compared to US population, as well as north and west Indian populations. Thirty-two percent subjects were in the highest risk category with serum cholesterol exceeding 239 mg/dL, while in the US population this fraction constituted only 18 percent. Other risk factors such as high blood pressure, obesity, diabetes, sedentary lifestyle and smoking also had a high prevalence in this population. In this settlement of urban residents in Thiruvananthapuram, serum total cholesterol and low-density lipoprotein cholesterol are high. The causes are likely to be dietary. Combined with the high prevalence of other risk factors such as obesity, hypertension, smoking, diabetes and lack of exercise, this situation demands a preventive programme.
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Joseph A. An interview of Abraham Joseph. Interview by Jane Westberg. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2000; 13:407-413. [PMID: 14742068 DOI: 10.1080/135762800750059534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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166
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Sudhindra TV, Joseph A, Hacking CJ, Haray PN. Are surgeons aware of the dangers of diathermy? Ann R Coll Surg Engl 2000; 82:31-2. [PMID: 10700764 PMCID: PMC2503440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Surgical diathermy is an invaluable aid in modern surgery and most contemporary diathermy machines are considered safe. However, diathermy accidents still do occur and a diathermy unit can be potentially lethal if adequate care is not exercised in its use.
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167
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Bose A, George K, Joseph A. Drowning in childhood: a population based study. Indian Pediatr 2000; 37:80-3. [PMID: 10745393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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168
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Belakhlef A, Allia H, Babchyck B, Joseph A, Margouleff D, Zanzi I. Effects of Out-of-Field Radiation on Dual-Head Gamma Camera Imaging in Coincidence Mode. CLINICAL POSITRON IMAGING 1999; 2:334. [PMID: 14516631 DOI: 10.1016/s1095-0397(99)00094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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169
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Raman Kutty V, Joseph A, Soman CR. High prevalence of type 2 diabetes in an urban settlement in Kerala, India. ETHNICITY & HEALTH 1999; 4:231-239. [PMID: 10705560 DOI: 10.1080/13557859998010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Prevalence of type 2 or non insulin dependent diabetes mellitus is high among Indians living in India as well as abroad. Prevalence among persons of Indian origin in many countries is greater than that of people of other ethnic extraction. The Indian state of Kerala is distinguished by a high level of achievement in the health sector, characterised by both lower mortality rates and greater density of health care institutions that ensure access to most people. These attributes make the prevalence of diabetes and the pattern of its management in Kerala worth studying. OBJECTIVE To estimate the prevalence of diabetes among persons 20 years or older in an urban housing settlement in Trivandrum city, the capital of Kerala, as well as study the management of the disease in subjects affected. DESIGN Cross sectional survey for detecting diabetes and other chronic diseases in all willing residents of an urban housing settlement in Trivandrum, the capital city of Kerala, as part of a preventive campaign against lifestyle diseases. Fasting plasma glucose, serum triglycerides, cholesterol, height, weight and blood pressure were measured, and a detailed questionnaire administered to ascertain previous diabetic status and management. RESULTS Overall prevalence of type 2 diabetes is 16.3%. In the 30-64 age group, age standardised prevalence is 13.7%. Gender differences in prevalence are negligible. Greater prevalence is associated with advancing age, body mass index above 24.99, sedentary habits, serum total cholesterol > 239, serum triglycerides > 149, hypertension and smoking. Compared to non-diabetics, diabetics have greater mean and range of fasting plasma glucose values (8.87 +/- 3.6 mM/l as against 4.34 +/- 0.53 mM/l). 32 out of 38 diabetics among the subjects (82.4%) were already diagnosed even before the survey; of them, 89% were on medication. 3% of subjects had impaired fasting glucose, or FPG level between 110-125 mg/dl. CONCLUSION Prevalence of type 2 diabetes among a group of urban residents in Trivandrum city in Kerala is very high. This is associated also with a high detection rate and compliance to treatment.
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Graff L, Prete M, Werdman M, Monico E, Smothers K, Krivenko C, Maag R, Joseph A, Klopfer L. Outcomes with observation units for chest pain evaluation in a multihospital network. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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171
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Bose A, Sinha S, Choudhary N, Aruldas K, Moses PD, Joseph A. Experiences of neonatal care in a secondary level hospital. Indian Pediatr 1999; 36:802-6. [PMID: 10742736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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172
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Kuruvilla A, Pothen M, Philip K, Braganza D, Joseph A, Jacob KS. The validation of the Tamil version of the 12 item general health questionnaire. Indian J Psychiatry 1999; 41:217-21. [PMID: 21455393 PMCID: PMC2962995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The 12 item General Health Questionnaire (GHQ-12), increasingly used to screen for common mental disorders (CMD) in primary care, has been validated in different languages and cultures. However, the validity of the Tamil version has not been established. Consecutive patients, attending a primary health care centre in Vellore, rural Tamil Nadu, India, were screened for CMD using the Tamil version of the GHQ-12. The subjects were also interviewed using the Revised Clinical Interview Schedule (CIS-R). The International Classification of Diseases-10: Primary care version (ICD-10 PHC) criteria were used to diagnose CMD. Various thresholds of the GHQ-12 were compared against the standards of the ICD-10 PHC. A receiver operator characteristic curve was drawn to obtain the best threshold value for screening. Principal Component Analysis was done to identify latent variables. The Cronbach's alpha and the split half reliability were also calculated. One hundred and eleven (33%) subjects of the 327 patients interviewed satisfied ICD-10 PHC criteria for CMD. The optimal threshold for the GHQ-12 was 2/3. This threshold had a sensitivity 87.4% and a specificity of 79.2%. Three factors were extracted with eigen values of 5.0 (depression-anxiety), 1.7 (social performance) and 1.1 (self-esteem) which explained 42.0%, 13.9% and 9.2% of the variance. The Cronbach's alpha was 0.86 while the split half-reliability was 0.83. The sensitivity and specificity of the Tamil version of the GHQ-12 is high. The factor structure is similar to that reported in other populations. The instrument can be employed as a screening instrument in this population.
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Kuruvilla S, Joseph A. Identifying disability: comparing house-to-house survey and rapid rural appraisal. Health Policy Plan 1999; 14:182-90. [PMID: 10538721 DOI: 10.1093/heapol/14.2.182] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study compared house-to-house survey and rapid rural appraisal as methods used to identify people with disabilities in a sample rural population in South India. The research showed that by using these methods, two distinctly different populations were identified. The factors that influenced the identification processes were: local perceptions and definitions of disability; social dynamics, particularly those of gender and age; relationships within the rapid rural appraisal groups and between the health auxiliary and the respondents in the house-to-house survey; and the type of disability and the associated social implications and stigma of that disability. While a few more people were identified through the house-to-house survey, the rapid rural appraisal was a better approach for identifying disability in the community because of the greater community participation. The researchers believe that this community participation provided a greater understanding of the complex contextual dynamics influencing the identification of disability, thereby increasing the validity of the study findings. Another advantage of the rapid rural appraisal was the methodological and analytical simplicity. Both methods, however, failed to identify some individuals with disabilities who were later identified on the follow-up verification visits. Taking into account the factors discussed above, the researchers conclude that no single method could be used to comprehensively identify people with disability in a community. They suggest that a judicious combination of methods which takes into account local perceptions and priorities, includes more specific screening techniques, and facilitates informed voluntary referrals, would be the most effective approach.
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Rupa V, Jacob A, Joseph A. Chronic suppurative otitis media: prevalence and practices among rural South Indian children. Int J Pediatr Otorhinolaryngol 1999; 48:217-21. [PMID: 10402118 DOI: 10.1016/s0165-5876(99)00034-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In order to determine the prevalence of chronic suppurative otitis media (CSOM) in rural South Indian children, a cross-sectional survey was conducted among 914 children (484 boys and 430 girls) from four primary schools and 12 nurseries (balwadis; preschool), of adjacent villages of North Arcot District of Tamil Nadu state. The preschool children were aged 2-5 years, while the ages of the primary school children ranged from 6 to 10 years. The overall prevalence rate of CSOM was found to be 6%. The disease was equally prevalent in preschool children (5.7%) and primary school children (6.2%) (P = 0.94). Cholesteatomatous ear disease was observed in 1.2% of children, those of the older age group having a slightly higher prevalence rate (1.5%) than the younger age group (0.7%). Parental beliefs and existing practices with respect to the disease are also presented.
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Joseph A. The role of platelets and platelet glycoprotein IIb/IIIa receptor inhibition in acute coronary syndromes: an educational supplement. Introduction. J Emerg Med 1999; 17:565. [PMID: 10338257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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