Non-allergic rhinitis: a case report and review

Rhinitis is characterized by rhinorrhea, sneezing, nasal congestion, nasal itch and/or postnasal drip. Often the first step in arriving at a diagnosis is to exclude or diagnose sensitivity to inhalant allergens. Non-allergic rhinitis (NAR) comprises multiple distinct conditions that may even co-exist with allergic rhinitis (AR). They may differ in their presentation and treatment. As well, the pathogenesis of NAR is not clearly elucidated and likely varied. There are many conditions that can have similar presentations to NAR or AR, including nasal polyps, anatomical/mechanical factors, autoimmune diseases, metabolic conditions, genetic conditions and immunodeficiency. Here we present a case of a rare condition initially diagnosed and treated as typical allergic rhinitis vs. vasomotor rhinitis, but found to be something much more serious. This case illustrates the importance of maintaining an appropriate differential diagnosis for a complaint routinely seen as mundane. The case presentation is followed by a review of the potential causes and pathogenesis of NAR

Asthma Prevalence and Severity in Arab American Communities in the Detroit Area, Michigan

Immigrant populations provide a unique intersection of cultural and environmental risk factors implicated in asthma etiology. This study focuses on asthma prevalence and severity in 600 Arab American households in metro Detroit, the largest immigrant reception zone for Arab Americans in North America. The survey method introduced a number of novel features: (a) a ranking scheme for the key environmental risk factors for asthma was used to derive an aggregated environmental risk index (ERI) for each household, and (b) an aggregate measure of asthma severity based on symptom frequency and intensity. Environmental risk factors and surrogates for socioeconomic status (SES) were found to be stronger predictors of asthma prevalence than asthma severity, while demographic variables such as English fluency and birth in the United States were better predictors of asthma severity than asthma prevalence. These results suggest that SES variables may be more reflective of environmental exposures in communities involved in this study, while English fluency and birth in the United States may be linked to health care access and utilization behavior that can influence the asthma management. We also found a significant relationship between asthma prevalence and degree of acculturation. Asthma prevalence was highest among moderately acculturated immigrants compared with new immigrants and those who were well acculturated, suggesting that among Arab Americans in the Detroit area, risk factors associated with new immigrant status are replaced by “western” risk factors as the population becomes more acculturated.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44945/1/10903_2005_Article_3673.pd

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Structural and systemic dimensions of school segregation in French-speaking Belgium

Notwithstanding more than a century of policies aimed at school democratisation, the education system in French-speaking Belgium is characterised by the persistence of sharp social inequalities in outcomes. These inequalities reflect considerable phenomena of segregation observed between streams and between schools (Lafontaine, 2005; Lafontaine et al., 2003; Jacobs et al., 2009). The structural causes of this situation are well documented in the literature (see in particular Lafontaine and Monseur, 2011; Dumay, Dupriez and Maroy, 2010; Danhier et al., 2014) and researchers generally agree that segregation between school environments can be attributed in large part to the combined effects of a quasi-market regulation of the system and a considerable institutional differentiation of educational provision. Following a brief presentation of the definition of school segregation that will be used in this chapter, we review these two main mechanisms and their political and socio-historical roots. We then describe several indicators of social, academic (i.e., according to students' educational attainment) and ethnic segregation in the education system in French-speaking Belgium and bring out how, paralleling the spread of such indicators, the concept of segregation has gradually entered public debate on the school. In the final section we address the policies that have been adopted to combat school segregation and the accompanying social inequalities

Evaluation of the Enhanced Engagement and Relational Support Service (EERSS) within the Offender Personality Disorder (OPD) pathway

This was a mixed methods cross-sectional study evaluating OPD EERSS services in London. This included whether engagement with EERSS improved service participants? well-being and relationships with others, and reduced risk. Participants completed self-reported measures on working alliance, psychological distress, and well-being; and at different time points of service participation, were compared on outcomes including risk and attendance at statutory appointments. EERSS were compared to two control groups; the Intensive Intervention Risk Management Service (IIRMS) group, and a ?no-intervention? OPD screened-in group. A subsample of EERSS participants took part in qualitative interviews. Findings highlighted the positive impact of EERSS and IIRMS; in particular, that participants in those services improved their attendance at statutory probation appointments, compared to controls. There was a positive indication of improvement in well-being and risk. Qualitative findings identified aspects of the therapeutic alliance which improved well-being and engagement with probation. In conclusion, EERSS added value to the OPD pathway and may be deserving of wider rollout