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Describir las observaciones y percepciones de los médicos sobre los pacientes con esquizofrenia y obtener información sobre sus prácticas de prescripción de antipsicóticos.
Psiquiatras de Estados Unidos y de cinco países europeos (Francia, Alemania, Italia, España y Reino Unido), que prescribieron antipsicóticos a ≥ 15 pacientes con esquizofrenia en los 3 meses precedentes, proporcionaron datos sobre las características demográficas y clínicas de sus pacientes y sus prácticas de prescripción de antipsicóticos y características del fármaco que influyeron en la eleccción del mismo.
Se recogieron datos de 872 médicos sobre 6.523 pacientes (un 85% de europeos, un 15% de Estados Unidos). La mayoría de los pacientes tenía 25-44 años, el 63% eran hombres y el 66% se trataban de forma ambulatoria. Aproximadamente, el 50% de los pacientes sufrían disfunción moderada a grave; cerca del 50% estaban desempleados y el 34% y el 75% tomaban antipsicóticos convencionales o atípicos, respectivamente. Los síntomas positivos identificados con más frecuencia fueron ideas delirantes (73%), pensamiento desorganizado (59%) y alucinaciones (59%); los síntomas negativos más comunes fueron aislamiento social (54%), pobreza del pensamiento (39%) y afecto embotado (38%). Los motivos principales para la selección del antipsicóticofueron eficacia para los síntomas positivos (90%) o negativos (62%) y tolerabilidad (47%). Los síntomas negativos (71-77%) se controlaron inadecuadamente con más frecuencia que los positivos (47-60%). Algunos efectos adversos fueron sedación, aumento de peso y síntomas extrapiramidales.
En esta encuesta de gran tamaño, transversal multinacional, los médicos afirmaron que los síntomas positivos eran más comunes que los negativos. El tratamiento de los síntomas positivos fue más satisfactorio que el de los síntomas negativos, considerando los médicos que el tratamiento era inadecuado en más del 70% de los pacientes con síntomas negativos.
To describe physicians' observations and perceptions of patients with schizophrenia and to obtain information about antipsychotic prescribing practices.
Psychiatrists in the United States and five European countries (France, Germany, Italy, Spain, and the United Kingdom) who prescribed antipsychotics for ≥15 patients with schizophrenia within the preceding 3 months provided data on their patients' demographic and clinical characteristics and their antipsychotic prescribing practices and drug attributes influencing treatment choice.
Data were collected from 872 physicians on 6523 patients (85% European, 15% US). Most patients were aged 25–44 years, 63% were men, and 66% were outpatients. About 50% of patients were moderately to grossly dysfunctional; about 50% were unemployed; 34% and 75% were taking conventional or atypical antipsychotics, respectively. Frequently identified positive symptoms included delusions (73%), disordered thought (59%), and hallucinations (59%); common negative symptoms included social withdrawal (54%), impoverished thought (39%), and blunted affect (38%). Reasons for antipsychotic selection included efficacy for positive (90%) or negative symptoms (62%) and tolerability (47%). Inadequate control was reported more frequently for negative (71–77%) than positive (47–60%) symptoms. Adverse events included sedation, weight gain, and extrapyramidal symptoms.
In this large, multinational, cross-sectional survey, physicians reported that positive symptoms were more common than negative symptoms. Treatment for positive symptoms was more successful than that for negative symptoms, with physicians considering treatment inadequate for >70% of patients with negative symptoms.
The New York City Watershed Agricultural Program seeks to reduce the potential for phosphorus movement from farms to surface waters. A “phosphorus index for site evaluation” (P-index) provides planners in the New York City Watershed Agricultural Program with a tool for identifying individual farm business, phosphorus related problems, and evaluating solutions. A linear programming model is employed to examine dairy farm resource use and profitability, with the P-index used to impose phosphorus movement constraints. Results indicate dramatic differences in farm resource use and farm business profitability depending on the level of the P-index. Small changes in the target index level result in large shifts in optimal resource use and business profitability. These differences illustrate that restrictions on phosphorus movement from land to surface waters potentially have major impacts on resource use and farm profitability in the New York City Watershed.
Zero runoff subirrigation (ZRS) technology can effectively manage fertilizer input while improving greenhouse production efficiency. However, high capital investment costs and inadequate technical information to growers are impediments for adoption. A Monte Carlo simulation was used to compare the profitability and risks of alternative ZRS system investments for greenhouse operations in the northeastern and north central United States. Results showed that the Dutch movable tray system and the flood floor system were most profitable and least risky for small potted plant and bedding crop flat production, respectively. The trough bench system was least favorable because its profitability was low and highly volatile.
This article reports the results of research regarding the farm-level implications for New York dairy producers of national mandatory supply control programs for feed grains and milk. The analysis is based on the proposed Harkin-Gephardt Bill which would authorize a mandatory supply control program for milk and the major supported crops. Representative farm budgets were constructed for a sample of dairy farms to assess the possible effects on costs and returns. Some farmers would gain, while others would not. The results suggest that dairy farmers who purchase all of their feed would be worse off, while farmers who grow grain would be better off under the proposed supply control program.
Cow-calf enterprises in the Northeastern United States are generally small and often the only agricultural enterprise of families with large off-farm incomes. In this paper, the economic viability of cow-calf enterprises to these investors is considered using a representative farm/economic engineering approach. Investments in farm real estate that is characterized by limited capability soil resources are found to yield negative labor and management incomes but to be economically viable when change in net worth and present value of family after-tax income are considered.
On most Northeastern dairy farms bull calves are considered a superfluous output and are sent to auction markets as soon as possible after they are born. The excess supply situation in the United States dairy industry combined with other obstacles to dairy herd expansion has resulted in dairy producers seeking expansion options other than increased dairy herd size. Several alternatives for expanding the dairy farm business that utilize bull calves as a resource are possible. Dairy beef systems that are most complementary to the ongoing dairy business should be particularly attractive.
In the April, 1981, issue of this Journal, Prindle and Livezey (PL) address the very important question of how a dairy farm manager should attempt to adjust production in response to expected seasonal production patterns of the dairy cow, monthly milk prices and variable milk production costs. The authors construct a representative farm linear programming model to address this important question.
Researchers and extension personnel interested in dairy systems recognize the importance of high quality hay. It is generally assumed that feeding a higher quality hay should result in increased quantities of hay in the least cost balanced ration and thereby reduce total ration cost (Chase). The objective of this article is to quantify the direction and magnitude of changes in dairy cow ration composition and cost with increased hay crop quality.
Nearly level terrain, heavy soils, and impermeable subsoil horizons commonly cause poor drainage in Northern New York. Forty-five percent of the cropland in this region is classified as poorly drained (Lucey). The soils in this area dry slowly, consequently restricting the effective length of the growing season. Production of corn is marginal and the establishment of legume seedings is prevented by poor drainage. Poor drainage is only a single characteristic of a farm's soil resource, but it has multiple effects. Farm managers have adjusted to poor drainage by using grass hay crops as a forage base and by adopting other management practices which utilize land more extensively.
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