Background. Rubella and congenital rubella syndrome remain a problem in the United States; institutionalized individuals are at higher risk. We assessed demographic variables and rubella serology in a population of institutionalized adults with mental retardation. Methods. Subjects were 181 institutionalized adults with mental retardation. We reviewed charts to determine patient's age, sex, race, and fertility status (if female), cause of mental retardation, and rubella history. Serologic testing to determine rubella immunity was done. Results. We found that 26.4% of subjects were nonimmune. Sex, cause of mental retardation, and history of rubella vaccination were not related to serologic immunity status. Of the 29 fertile female subjects, 8 (27.6%) were nonimmune to rubella. Conclusion. Subjects with unknown immunization status had a similar serologic profile to those whose medical records indicated immunization. Neither history of infection nor immunization was predictive of serology status.

Many pregnancies are predisposed to complications by events that occur in the first weeks of gestation. In fact, these complications may occur prior to the time that a woman knows she has become pregnant. Preconception care offers patients the opportunity to address these conditions before conception; the potential for a satisfactory pregnancy outcome is thereby increased. In the following report, I summarize current understandings in preconception care. Recent advances in preconception care have expanded the opportunities for preventing adverse reproductive outcome. Although the study of preconception care is a relatively new innovation, recent studies have shown the value of preconception intervention.

We are still far from understanding the intricacies of the relationship of the ovary and uterus. The best insurance for an implantation is a healthy secretory endometrium, and development of secretory phase endometrium is a result of luteal phase progesterone secretion, which is dependent on estrogen priming. The first place to look for failure of implantation is in altered follicle development and ovulation. Even the most ardent supporters of endometrial biopsy as an assay do not support its use for ovulation detection. Although it is a generally reliable technique, it has been replaced by other, less invasive methods for ovulation detection. Unfortunately, many still use it as a part of the first line approach in the infertility evaluation. If it has a role, it should be relegated to a later stage, perhaps used when the cause of the infertility has not been forthcoming. The role of LPD in fertility is more conceptually sound than objectively proven. It is the endometrial biopsy that allowed this diagnosis, and it is the possibility of this diagnosis that remains the primary, if not only, indication.

Study objective: To assess pregnant women's understanding of sexual abuse prevalence and perpetrator characteristics. Design: A multiple choice questionnaire concerning knowledge about sexual abuse prevalence and an understanding of potential perpetrators was presented to patients. Comparisons were made based on participant's age, educational status, and personal involvement in the care of children. Setting: Prenatal clinic, Department of OB/GYN, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee. Participants: Patients presenting for new obstetrical evaluation (N = 289). Main Outcome Measures: Responses to the questionnaire. Results: Less than half of the subjects correctly answered questions about sexual abuse prevalence. Only 22% of patients understood the potential youthfulness of juvenile sex offenders. Neither age nor child care responsibilities affected response. Subjects with greater than 12 years of formal education achieved significantly higher scores than those with less edu cation. 59% of respondents were interested in more information. Conclusion: Pregnant women's knowledge about the dangers of sexual abuse was suboptimal in this population. The majority of patients were interested in more information.

Objective: To determine the most common forms of childhood exotropia. Design: Retrospective, consecutive, observational case series. Participants: All exotropic children (with ≥10 prism diopters) younger than 19 years from a predominantly rural Appalachian region evaluated from August 1, 1995 through July 31, 2001. Methods: Demographic and clinical data were collected on all patients. Main Outcome Measures: The relative proportion of the various forms of childhood exotropia. Results: Two hundred thirty-five consecutive children without prior surgical treatment were evaluated for exotropia. Of the 235 study children, the specific forms of exotropia diagnosed and numbers were as follows: intermittent exotropia, 112 (47.7%); exotropia associated with congenital or acquired abnormalities of the central nervous system (CNS), 50 (21.3%); convergence insufficiency, 27 (11.5%); sensory exotropia, 24 (10.2%); paralytic exotropia, 5 (2.1 %); congenital exotropia, 4 (1.7%); neonatal exotropia that resolved after 4 months of age, 3 (1.3%), whereas the remaining 10 (4.3%) had an undetermined form of exodeviation. Conclusions: Intermittent exotropia was the most common form of divergent strabismus in this population. Exotropia associated with an abnormal CNS, convergence insufficiency, and sensory exotropia were also relatively common, whereas the congenital, paralytic, and late-resolving neonatal forms were uncommon.

No description available.

ABSTRACT: The 2001 anthrax bioterrorism attacks demonstrated vulnerability for future similar attacks. This article describes mechanisms that can be used to prepare the medical community and healthcare facilities for the diagnosis and management of a subsequent bioterrorism attack should such an event occur and the fundamentals of medical simulation and its use in teaching learners about the diagnosis of management of anthrax exposure.

Background: Since the passage of The Dietary Supplement Health and Education Act in 1994, there has been a flood of new 'dietary' supplements promoting anti-aging benefits such as the enhancement of growth hormone or testosterone levels. Androstenediol and androstenedione are such products. This study's purpose was to elucidate the physiological and hormonal effects of 200 mg/d of oral androstenediol and androstenedione supplementation in men aged 35 to 65 years while participating in a 12-week high-intensity resistance training program. Methods: Fifty men not consuming any androgenic-enhancing substances and with normal total testosterone levels, prostate-specific antigen, hemoglobin, and hematocrit, and with no sign of cardiovascular or metabolic diseases participated. Subjects were randomly assigned to a placebo, androstenediol (diol), or androstenedione (dione) group using a double-blind study design. Main outcomes included serum sex hormone profile, body composition assessment, muscular strength, and blood lipid profiles. Results: During the 12 weeks of androstenedione or androstenediol use, a significant increase in the aromatization by-products estrone and estradiol was observed in both groups (P=.03). In the dione group, total testosterone levels significantly increased 16% after 1 month of use, but by the end of 12 weeks, they returned to pretreatment levels. This return to baseline levels resulted from increases in aromatization and down-regulation in endogenous testosterone synthesis based on the fact that luteinizing hormone was attenuated 18% to 33% during the treatment period. Neither androstenediol nor androstenedione enhanced the adaptations to resistance training compared with placebo for body composition or muscular strength. However, both androstenediol and androstenedione supplementation adversely affected high-density lipoprotein cholesterol (HDL-C) levels, coronary heart disease risk (representing a 6.5% increase), and each group's respective (low-density lipoprotein cholesterol [LDL-C]/HDL-C)/(apolipoprotein A/apolipoprotein B) lipid ratio (diol: +5.2%; dione: +10.5%; P=.05). In contrast, the placebo group's HDL-C levels increased 5.1%, with a 12.3% decline in the (LDL-C/HDL-C)/(apolipoprotein A/apolipoprotein B) lipid ratio. These negative and positive lipid effects occurred despite no significant alterations in body composition or dietary intakes in the supplemental groups or placebo group, respectively. Conclusions: Testosterone precursors do not enhance adaptations to resistance training when consumed in dosages recommended by manufacturers. Testosterone precursor supplementation does result in significant increases in estrogen-related compounds, dehydroepiandrosterone sulfate concentrations, down-regulation in testosterone synthesis, and unfavorable alterations in blood lipid and coronary heart disease risk profiles of men aged 35 to 65 years.

No description available.

ABSTRACT: The 2001 anthrax bioterrorism attacks demonstrated vulnerability for future similar attacks. This article describes mechanisms that can be used to prepare the medical community and healthcare facilities for the diagnosis and management of a subsequent bioterrorism attack should such an event occur and the fundamentals of medical simulation and its use in teaching learners about the diagnosis of management of anthrax exposure.