Pain in traumatic upper limb amputees in Sierra Leone.

Data on 40 upper limb amputees (11 bilateral) with regard to stump pain, phantom sensation and phantom pain is presented. All the patients lost their limbs as a result of violent injuries intended to terrorise the population and were assessed 10-48 months after the injury. All amputees reported stump pain in the month prior to interview and ten of the 11 bilateral amputees had bilateral pain. Phantom sensation was common (92.5%), but phantom pain was only present in 32.5% of amputees. Problems in translation and explanation may have influenced the low incidence of phantom pain and high incidence of stump pain. In the bilateral amputees phantom sensation, phantom pain and telescoping all showed bilateral concordance, whereas stump pain and neuromas did not show concordance. About half the subjects (56%) had lost their limb at the time of injury (primary) while the remainder had an injury, then a subsequent amputation in hospital (secondary). There was no association between the incidence of phantom pain and amputation irrespective of being primary or secondary

Hemidactylus mabouia

Number of Pages: 11Integrative BiologyGeological Science

The Lizards of Rarotonga and Mangaia, Cook Island Group, Oceania

Eight species of lizards are reported from the islands of Rarotonga and Mangaia with comments on their distribution, ecology, reproduction, and variation. Particular attention is given to systematic problems in the genus Cryptoblepharus and pattern polymorphism in Emoia cyanura. Emoia trossula, recently described from Fiji, is reported for the first time in the Cook Islands. Historic and zoogeographic evidence suggests that most species of lizards arrived on Rarotonga and Mangaia in Polynesian voyaging canoes within the past 1000 years, although Gehyra mutilata and Hemidactylus garnotii may have arrived by incidental boat or air transport in the past several decades

The herpetofauna of the Babuyan Islands, Northern Philippines

We document 52 species of amphibians and reptiles from the Babuyan Islands in the northern Philippines. Among these records, 12 species are endemic to the Babuyan Islands and another 18 are endemic to the Philippines. Prevalence of endemic forms in the island group is high, with 1–3 island-endemic species present in each of the major islands. The present-day assemblage of herpetofauna in the island group is attributed to dispersal from Luzon and subsequent diversification. No evidence of successful southward colonization of species from Taiwan is found. Based on data from our own surveys, and to enable future work, we provide an updated list of the species from the Babuyan and Batanes Island groups. Molecular phylogenetic studies are recommended to gain more insights into the evolutionary history of the island-endemic forms and the biogeography of the small islands between Luzon and Taiwan

Latex allergy at Groote Schuur hospital prevalence, clinical features and outcome

Background. The incidence of latex allergy is increasing worldwide but there is very little information available on the clinical outcome for affected individuals.Objective. To determine the prevalence of latex allergy at Groote Schuur Hospital, a large teaching hospital in Cape Town, and to study the outcome for affected individuals.Method. Using a questionnaire, we screened 2 316 hospital workers for the presence of work-related symptoms. Workers who were symptomatic had Immunocap RAST (CAP RAST) or skin-prick tests to confirm latex sensitivity. Latexavoidance measures were implemented in positive subjects. One hundred symptomatic, sensitised individuals were followed up 3 months after intervention to assess their clinical status. A further cohort of 25 individuals with ongoing nasal symptoms were studied in detail.Results. Latex sensitisation was confirmed in 182 of 717 symptomatic workers (25.3%). SenSitised symptomatic workers were significantly more likely to have had a previous history of urticaria (P = < 0.001), oral allergy syndrome (P = < 0.001), or allergic conjunctivitis (P = 0.001), but not hay fever, perennial rhinitis, eczema or insect allergies. Latex sensitisation occurred among all classes of health care workers. Ocular and cutaneous symptoms were significantly associated with positive latex sensitisation (P = < 0.001). After latex intervention, ocular symptoms (P = < 0.001), skin rashes (P = < 0.001) and wheezing (P = 0.001) reduced significantly. Nasal symptoms did not improve. Undiagnosed and untreated underlying allergies to common aero-allergens were present in the majority of latexsensitised patients with ongoing nasal symptomatology.Conclusion. The prevalence of symptomatic sensitisation to latex allergy at Groote Schuur Hospital is between 9.2 and 11.2%. Ocular and cutaneous symptoms are the most prevalent in sensitised workers, and unlike nasal symptoms are significantly reduced when latex-avoidance measures are introduced. Ongoing nasal symptoms after intervention is instituted are probably due to other allergic sensitivities in latex-sensitised health care workers

Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: A meta-analysis

PURPOSE Depression is common in primary care. There are no systematic reviews of depression treatment comparing antidepressants with placebo; hence, we do not know whether these medications are effective in primary care.METHODS We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Group register of controlled trials, MEDLINE, International Pharmaceutical abstracts, PsycINFO, and EMBASE. Abstracts of potential studies were reviewed independently by 2 authors. Studies needed to include randomized controlled trials of either a tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI), or both, and placebo in a primary care setting. The data and quality of the studies were extracted and assessed by 2 authors blind to the other’s choice. Disagreements were resolved by discussion. The main outcome measures were the standardized mean difference and weighted mean difference of the final mean depression scores, the relative risk of improvement, and the number withdrawing because of side effects. Pooling of results was done using Review Manager 4.2.2.RESULTS There were 10 studies in which TCAs were compared with placebo, 3 in which SSRIs were compared with placebo, and 2 with both compared with placebo. One half of the studies were of low methodological quality, and nearly all studies were of short duration, typically 6 to 8 weeks. Pooled estimates of efficacy data showed a relative risk of 1.26 (95% CI, 1.12–1.42) for improvement with TCAs compared with placebo; For SSRIs, relative risk was 1.37 (95% CI, 1.21–1.55). Most patients, 56% to 60%, responded well to active treatment compared with 42% to 47% for placebo. The number needed to treat for TCAs was about 4, and for SSRIs it was 6. The numbers needed to harm (for withdrawal caused by side effects) ranged from 5 to 11 for TCAs and 21 to 94 for SSRIs. Low-dose (100 mg or 75 mg) as well as high-dose TCAs were effective.CONCLUSION This systematic review is the first comparing antidepressants with placebo for treatment of depression in primary care. Both TCAs and SSRIs are effective. This review is also the first to show that low-dose TCAs are effective in primary care. Prescribing antidepressants in primary care is a more effective clinical activity than prescribing placebo

Use of measurement theory for operationalization and quantification of psychological constructs in systems dynamics modelling

The analytical tools available to social scientists have traditionally been adapted from tools originally designed for analysis of natural science phenomena. This article discusses the applicability of systems dynamics - a qualitative based modelling approach, as a possible analysis and simulation tool that bridges the gap between social and natural sciences. After a brief overview of the systems dynamics modelling methodology, the advantages as well as limiting factors of systems dynamics to the potential applications in the field of social sciences and human interactions are discussed. The issues arise with regards to operationalization and quantification of latent constructs at the simulation building stage of the systems dynamics methodology and measurement theory is proposed as a ready and waiting solution to the problem of dynamic model calibration, with a view of improving simulation model reliability and validity and encouraging the development of standardised, modular system dynamics models that can be used in social science research

Design and feasibility testing of a novel group intervention for young women who binge drink in groups

BackgroundYoung women frequently drink alcohol in groups and binge drinking within these natural drinking groups is common. This study describes the design of a theoretically and empirically based group intervention to reduce binge drinking among young women. It also evaluates their engagement with the intervention and the acceptability of the study methods.MethodsFriendship groups of women aged 18–35 years, who had two or more episodes of binge drinking (>6 UK units on one occasion; 48g of alcohol) in the previous 30 days, were recruited from the community. A face-to-face group intervention, based on the Health Action Process Approach, was delivered over three sessions. Components of the intervention were woven around fun activities, such as making alcohol free cocktails. Women were followed up four months after the intervention was delivered. Results The target of 24 groups (comprising 97 women) was recruited. The common pattern of drinking was infrequent, heavy drinking (mean consumption on the heaviest drinking day was UK 18.1 units). Process evaluation revealed that the intervention was delivered with high fidelity and acceptability of the study methods was high. The women engaged positively with intervention components and made group decisions about cutting down. Twenty two groups set goals to reduce their drinking, and these were translated into action plans. Retention of individuals at follow up was 87%.ConclusionsThis study successfully recruited groups of young women whose patterns of drinking place them at high risk of acute harm. This novel approach to delivering an alcohol intervention has potential to reduce binge drinking among young women. The high levels of engagement with key steps in the behavior change process suggests that the group intervention should be tested in a full randomised controlled trial