To provide pertinent background information on infectious diseases and injury in child day care and outline measures to address these health care needs.

To review the epidemiologic, clinical, and pathological characteristics and the public health implications of human immunodeficiency virus (HIV)-associated tuberculosis in sub-Saharan Africa.

To determine success and complication rates for lumbar spinal fusion surgery, predictors of good outcomes, and whether fusion improves success rates of laminectomy for specific low back disorders.

OBJECTIVE--The purpose of this article is to review the empirical evidence for the efficacy of a range of treatments for posttraumatic stress disorder (PTSD). Reviewed studies focused on rape victims, combat veterans, the tragically bereaved, torture victims, accident victims, of physical assault, and child abuse victims. DATA SOURCES--Peer-reviewed journals (Psych-Info, MEDLINE), book chapters (PILOTS database), active investigators, abstracts from the 1990 and 1991 International Society for Traumatic Stress Studies. STUDY SELECTION--We identified 255 English-language reports of treatment for PTSD. We restricted our focus to randomized, clinical trials that included a systematic assessment of PTSD using DSM-III or DSM-III-R criteria (N = 11). DATA EXTRACTION--Studies were assessed according to methodological strength: random assignment to the treatment of interest, and either an alternative treatment or control group; sample selection; and inclusion of statistical tests of significance. DATA SYNTHESIS--Drug studies show a modest but clinically meaningful effect on PTSD. Stronger effects were found for behavioral techniques involving direct therapeutic exposure, particularly in terms of reducing PTSD intrusive symptoms. However, severe complications have also been reported from the use of these techniques in patients suffering from other psychiatric disorders. Studies of cognitive therapy, psychodynamic therapy, and hypnosis suggest that these approaches may also hold promise. However, further research is needed before any of these approaches can be pronounced effective as lasting treatment of PTSD. CONCLUSIONS--Further studies should specifically address combined treatment approaches, optimal treatment length and timing, effects of comorbidity, and unstudied traumatized populations.

To examine the temporal relationship between accumulating data from randomized control trials of treatments for myocardial infarction and the recommendations of clinical experts writing review articles and textbook chapters.

To evaluate the treatment of bacterial vaginosis with metronidazole to determine if there is a therapeutic regimen that is superior to all others with regard to cure and recurrence rates.

Lipoprotein(a) (Lp[a]) can be defined as a lipoprotein particle having as a protein moiety apolipoprotein B-100 (the protein associated with low-density lipoprotein) disulfide-linked to apolipoprotein(a), the distinctive glycoprotein of Lp(a) that is homologous to plasminogen. Several forms of Lp(a) occur in the circulation. This polymorphism is related to the apolipoprotein(a) size heterogeneity that is controlled by the several alleles of the apolipoprotein(a) gene. High plasma levels of Lp(a) have been correlated with an increased risk for atherothrombotic cardiovascular disease by a mechanism that is as yet undefined. Pathogenicity may also derive from Lp(a) particles that have been modified by events believed to occur when Lp(a), after traversing the artery endothelium, reaches the intima. Aside from several promising leads, there are no universally accepted ways to lower high plasma Lp(a) levels. At this time, it is best to target efforts toward the modifiable risk factors by using appropriate diets and exercise programs and, whenever necessary, drug therapy.

Evidence collected over the last 20 years indicates that physical and sexual violence against women is an enormous problem. Much of this violence is perpetrated by women's intimate partners or in relationships that would presumably carry some protective aura (eg, father-daughter, boyfriend-girlfriend). This violence carries with it both short- and long-term sequelae for women and affects both their physical and psychological well-being. The high prevalence of violence against women brings them into regular contact with physicians; at least one in five women seen in emergency departments has symptoms relating to abuse. However, physicians frequently treat the injuries only symptomatically or fail to recognize the injuries as abuse. Even when recognized, physicians are often without resources to address the needs of abused women. This report documents the extent of violence against women and suggests path that the physician community might take to address the needs of victims.

To review the epidemiology, patterns, and major determinants of murder-suicide and to discuss the clinical and research strategies for identifying the individuals at greatest risk for this type of violence.

We evaluated the use of antifungal agents in the treatment of uncomplicated funguria by reviewing all case reports and studies regarding the treatment of funguria published in the English language from 1960 to 1991 (MEDLINE). Adult patients treated for uncomplicated funguria were included. Patients with fungal pyelonephritis and/or other systemic fungal manifestations were excluded from our analysis. All investigations were assessed for study design, sample size, definition of significant funguria, treatment regimen, inclusion of predisposing risk factors in outcome analysis, end points of therapy, and patient follow-up. Direct comparison of the studies on the use of antifungals in the treatment of uncomplicated funguria was not possible given the differing definitions of significant funguria, inconsistent reporting of risk factors, varying treatment regimens, end points of therapy, and duration of follow-up. Case reports and studies involving antifungals such as amphotericin B bladder irrigation, miconazole nitrate bladder irrigation, ketoconazole, and flucytosine were reviewed. Amphotericin B bladder irrigation appeared to be most effective and ketoconazole the least effective treatment of uncomplicated funguria. Predisposing risk factors, such as the presence of an indwelling urinary catheter, appear to play an important role in the persistence of positive cultures and failure of pharmacologic interventions. Until prospective, well-controlled studies are performed, no recommendation can be made for the treatment of uncomplicated funguria. In symptomatic patients therapy is indicated; however, the best regimen is unknown.