Final Recommendations from the World Health Organisation Commission on the Social Determinants of Health: Nurses, part of the solution? A discussion paper.

Aim This paper suggests that nursing needs a new paradigm for research and practice that recognises the social determinants of health as potentially preventable causes of ill health. It is clear from the recent report from the World Health Organisation Commission on the Social Determinants of Health that nurses are critical to global change through their ability to champion a `social determinants of health` approach with partner agencies. Data Sources Relevant literature searches have been undertaken to inform this discussion paper using the following databases in late 2008/early 2009 including the previous twenty years as relevant (British Nursing Index, Medline and Cinahl). In addition relevant international policy documents have been referred to from 2000 on. Discussion On the publication of this report it is timely for nurses to take stock of how they might be most effective in reducing inequities in health as part of a global work force and resource for health. Many nurses will feel that they already work to promote social justice and poverty reduction yet their scope of action is often limited by their specific sector. Do nurses need a new paradigm for research and practice that focuses on the social determinants of health as potentially preventable causes of ill health? Conclusion Nurses need to strengthen their strategic skills to reaffirm inequities in health as a priority within often complex local circumstances and to enable them and those they care for to influence local and national policy, research and practice development. Key words – health, inequities, nursing practic

DEMAND SYSTEM ANALYSIS WITH EMPHASIS ON CONTAINER SIZES OF NON-ALCOHOLIC BEVERAGES.

A demand system that includes five different beverages of various container sizes was estimated using a Censor Corrected Almost Ideal Demand System (CAIDS). Resulting elasticities provide information about intra-product relationships (same product but different sizes), intra-size relationships (different products same container size), and inter-product relationships (different products and different sizes).Demand and Price Analysis,

Natural History of Acute Subdural Hematoma

Although guidelines for surgical decision-making in patients with acute subdural hematomas (ASDHs) are widely available, the evidence supporting these guidelines is weak, and management of these patients must often be individualized. Smaller ASDHs in patients in good neurologic condition usually can be successfully managed without surgery. Large ASDHs with minimal mass effect in patients with minimal symptoms also may be considered for nonoperative management. The literature is divided about the effects of anticoagulant and antiplatelet medications on rapid growth of ASDHs and on their likelihood of progression to large chronic subdural hematomas, but it is reasonable to reverse the effects of these medications promptly. Close clinical and radiologic follow-up is needed in these patients, both acutely to detect rapid expansion of an ASDH, and subacutely to detect formation of a large subacute or chronic subdural hematoma

Neurosurgical and Perioperative Management of Chronic Subdural Hematoma

Objective:Surgery and specifically burr hole craniostomy is the most common first choice treatment of patients with Chronic Subdural Hematoma (CSDH). However, several aspects of neurosurgical and peri-operative management are still a subject of research, such as how to treat bilateral CSDH and the anesthetic approach. We aim to investigate the effect of the surgical approach to bilateral CSDH and the effect of anesthesia modality on outcome of CSDH patients. Methods:We retrospectively included surgically treated CSDH patients between 2005 and 2019 in three hospitals in the Netherlands. The effect of the surgical approach to bilateral CSDH (unilateral vs. bilateral decompression) and anesthesia modality (general vs. local anesthesia) on outcome (complications, recurrence, and length of hospital stay over 4 days) was studied with logistic regression adjusting for potentially confounding radiological and clinical characteristics. Results:Data of 1,029 consecutive patients were analyzed, mean age was 73.5 years (+/- 11) and 75% of patients were male. Bilateral CSDH is independently associated with an increased risk of recurrence within 3 months in logistic regression analysis (aOR 1.7, 95% CI: 1.1-2.5) but recurrence rate did not differ between primary bilateral or unilateral decompression of bilateral CSDH. (15 vs. 17%,p= 0.775). Logistic regression analysis showed that general anesthesia was independently associated with an increased risk of complications (aOR 1.8, 95% CI: 1.0-3.3) and with a length of hospital admission of over 4 days (aOR 8.4, 95% CI: 5.6-12.4). Conclusions:Bilateral CSDH is independently associated with higher recurrence rates. As recurrence rates in bilateral CSDH are similar for different surgical approaches, the optimal choice for primary bilateral decompression of bilateral CSDH could vary per patient. General anesthesia for surgical treatment of CSDH is associated with higher complication rates and longer hospital admission

Recurrence of chronic subdural hematoma due to low-grade infection

Despite the high incidence and multitudes of operative techniques, the risk factors for chronic subdural hematoma (CSDH) recurrence are still under debate and a universal consensus on the pathophysiology is lacking. We hypothesized that clinically inapparent, a low-grade infection could be responsible for CSDH recurrence. This investigation is a single-center prospective observational study including patients with recurrent CSDH. In total, 44 patients with CSDH recurrence received an intraoperative swab-based microbiological test. The intraoperative swab revealed an inapparent low-grade hematoma infection in 29% of the recurrent CSDH cases. The majority (69%) of the identified germs belonged to the staphylococcus genus. We therefore, propose a novel potential pathophysiology for CSDH recurrence