G98 Attention deficits in paediatric sickle cell disease; links with nocturnal oxygen desaturation in adolescents, but not children

Objective: Sickle cell disease (SCD) is associated with neurological compromise and cognitive difficulties. Tentative associations between cognitive difficulties and low daytime oxygen saturation (SpO2) are reported, but any effects of nocturnal desaturation are unknown. Methods: Sixteen children (8-12y, 6F) and twenty-four adolescents (13-18y, 11F) enrolled on the Prevention of Morbidity in Sickle Cell Disease phase-2 trial underwent cognitive assessment, which included the Wechsler Intelligence Scales, the Tower and Sorting tests from the Delis-Kaplan-Executive- Function System (D-KEFS) and the Conners Continuous Performance Test (CPT). Overnight oximetry was conducted within 2 weeks of assessment. Multiple deprivation indices (MDI) were derived from postcodes. Results: There were no significant differences between groups in any of the cognitive or oximetry measures. In adolescents, after correcting for the effects of MDI, relationships were found between mean nocturnal SpO2 and full-scale IQ (FSIQ; r=0.486, p=0.016), processing speed index (PSI; r=0.350, p=0.094) and working memory index (WMI: r=0.442, p=0.031), between minimum SpO2 and PSI (r=0.432, p=0.035) and tower time-time-per-move ratio (r=0.348, p=0.096), between the number of 3% oxygen dips per hour and the number of correct sorts (r=-0.447, p=0.029) and sorting descriptions (r=-0.438, p=0.032), and between the time spent with SpO2 <94% and FSIQ (r=-0.549, p=0.005), PSI (r=-0.434, p=0.034), and WMI (r=-0.464, p=0.022). In children the only significant relationship found was in the opposite direction; performance on the tower test was negatively related to mean SpO2 (r=-0.537, p=0.039). Findings were similar for the CPT. Conclusion: This study demonstrates, for the first time in SCD, links between nocturnal desaturation and difficulties in processing speed and executive function in adolescents but no similar links and a relationship in the opposite direction in children. These preliminary data may indicate that the effects of hypoxia on these domains only emerge over developmental time. Early interventions aimed at reducing hypoxic exposure may hold promise

Henri Albert Hartmann (1860-1952): colorectal master

The life and times of the coloproctologist Henri Hartmann (1860–1952) is presented outlining his contribution to surgery in general and to the field of colorectal surgery in particular

Unidade de contexto e observação social sistemática em saúde: conceitos e métodos Context unit and systematic social observation: a review of concepts and methods

Assumimos que "onde você mora é importante para sua saúde, para além de quem você é". Entendemos que o impacto do local de moradia ou unidade de contexto (UC) na saúde das populações se deve à heterogeneidade dos atributos do entorno físico e social da UC, para além das características individuais ou agregadas daqueles ali aninhados. Estes atributos, embora dependentes dos indivíduos, são tipicamente externos a eles e potencialmente modificáveis. As UC são compreendidas como unidades ecológicas inseridas em conjuntos sucessivamente mais amplos e interdependentes. Quando relevante para a hipótese do estudo, unidades geográficas administrativas podem ser utilizadas como aproximações da UC. Outra alternativa é a que utiliza a percepção de seus moradores, a "vizinhança percebida". O ressurgimento do interesse com relação à determinação dos efeitos da UC sobre a saúde correlaciona com novas tendências na área da saúde coletiva: incorporação de novos níveis hierárquicos de exposição, as iniqüidades e seus determinantes, a urbanização e seus efeitos e a avaliação de intervenções multi-setoriais. Nosso objetivo central é rever opções para a escolha da UC a ser investigada além de estratégias para a aferição de seus atributos físicos e sociais, utilizando a observação social sistemática (OSS). A combinação de dados originárias de dados administrativos, da vizinhança percebida, dos inquéritos populacionais e da OSS ainda necessita de maiores elaborações conceitual, metodológica e analítica. Entretanto, a compreensão da distribuição dos atributos físicos e sociais da UC permite compor níveis hierárquicos de complexidade relevantes para o entendimento da ocorrência dos eventos relacionados à saúde nas populações.<br>We understand that "where one lives makes a difference to health in addition to who you are", and that the effects of the place of residence or context unit (CU) on public health are due to the heterogeneity of the physical and social environment characteristics, in addition to the individual and aggregate attributes of the population nested in the CU. Those attributes, although intrinsically dependent on the individuals, are typically external to them and susceptible to intervention. Also, the UC's are understood as ecological units nested within successively larger communities. Depending on the study hypothesis, census-defined areas may be used as proxy for the CU. Alternatively, the CU may be defined by the individual's perception of his/her neighborhood. The renewed interest on the health effects of the CU are associated with new trends in public health, namely: new hierarchical levels of exposure beyond individual level characteristics, inequalities and social determinants of health, urbanization and the need to evaluate interventions not traditionally associated to public health. Our objective was, first, to review options while choosing the relevant CU and second, to review strategies to determine and quantify the characteristics of the CU using social systematic observation (SSO). The combination of census-defined data, information on the neighborhood defined by the local population, surveys and SSO still needs conceptual, methodological and analytical development. However, the distribution of the physical and social attributes of the CU will permit to incorporate other hierarchical level of complexity to better understand the incidence and prevalence of health related events in populations