Predictors of Health Among Refugee Adults from Myanmar and the Development of Their Children

The objective of this study is to attempt to understand predictors of health among adult migrants from Myanmar to Thailand and predictors of development among their children. EQ5D5L scores and sociodemographic data were obtained among adult household members of children from two schools on the Thai/Myanmar border. Children were administered Ages and Stages questionnaires (ASQs). OLS and logistic regressions were used to examine predictors (e.g., witnessing gunfire) of various outcome measures (e.g., ASQ scores among children). In logistic regression analyses, maternal literacy proved to be a very strong predictor of the child’s ASQ communication [17 ASQ points out of 60; 95 % confidence interval (CI) 3, 31 points], problem solving (25 points; 95 % CI 4, 45 points), and social skills (12 points; 95 % CI 1, 23 points) scores. A lower number of habitants/room predicted significantly better dentition among children [odds ratio (OR) 1.08, 95 % CI 1.01, 1.67] and better social skills on the child’s ASQ (12 points; 95 % CI 1, 23 points). Appliance ownership was a weak predictor of adult health, with those who own a refrigerator having about an 8 % higher score on the EQ5D5L (1.08; 95 % CI 1.01, 1.16). Finally, parents who witnessed gunfire tended to have children with ASQ scores that were 14 points lower than average in problem solving (95 % CI −24, −4). Maternal education programs may have a very large impact on the development of their children. However, identifying those households at greatest need of resources is not a simple task, and will require a more complete census of communities at risk

Climate change adaptation in conflict-affected countries:A systematic assessment of evidence

People affected by conflict are particularly vulnerable to climate shocks and climate change, yet little is known about climate change adaptation in fragile contexts. While climate events are one of the many contributing drivers of conflict, feedback from conflict increases vulnerability, thereby creating conditions for a vicious cycle of conflict. In this study, we carry out a systematic review of peer-reviewed literature, taking from the Global Adaptation Mapping Initiative (GAMI) dataset to documenting climate change adaptation occurring in 15 conflict-affected countries and compare the findings with records of climate adaptation finance flows and climate-related disasters in each country. Academic literature is sparse for most conflict-affected countries, and available studies tend to have a narrow focus, particularly on agriculture-related adaptation in rural contexts and adaptation by low-income actors. In contrast, multilateral and bilateral funding for climate change adaptation addresses a greater diversity of adaptation needs, including water systems, humanitarian programming, and urban areas. Even among the conflict-affected countries selected, we find disparity, with several countries being the focus of substantial research and funding, and others seeing little to none. Results indicate that people in conflict-affected contexts are adapting to climate change, but there is a pressing need for diverse scholarship across various sectors that documents a broader range of adaptation types and their results

Successful Treatment of Novel H1N1 Influenza related Fulminant Myocarditis with Extracorporeal Life Support

The prevalence of myocardial involvement in influenza infection ranges from 0% to 12%. The 2009 pH1N1 influenza virus, formerly known as swine flu, first appeared in Mexico and the United States of America in March and April 2009 and has swept the globe with unprecedented speed. We report a case of fulminant myocarditis associated with this virus treated successfully using extra-corporal membrane oxygenator

Fracture Risk in Men With Congestive Heart Failure Risk Reduction With Spironolactone

ObjectivesThe purpose of this study was to determine whether spironolactone use is associated with fractures in men with congestive heart failure (CHF).BackgroundIn rats with aldosteronism, spironolactone preserves skeletal strength. However, in humans, the relationship of spironolactone to fractures is not known.MethodsThe medical records of all male patients with CHF from 1999 to 2005 treated at the Veterans Affairs Medical Center, Memphis, Tennessee, were reviewed (n = 4,735). Odds ratios with 95% confidence intervals of having a fracture associated with spironolactone use were estimated using conditional logistic regression.ResultsWe identified 167 cases with a single-incident fracture and matched these by age and race to 668 control subjects without fractures. After adjustment for covariates, spironolactone use was inversely associated with total fracture (odds ratio: 0.575; 95% confidence interval: 0.346 to 0.955, p = 0.0324).ConclusionsThe use of spironolactone is inversely associated with fractures in men with CHF

How to misuse echo contrast

<p>Abstract</p> <p>Background</p> <p>Primary intracardiac tumours are rare, there are however several entities that can mimic tumours. Contrast echocardiography has been suggested to aid the differentiation of various suspected masses. We present a case where transthoracic echocardiography completely misdiagnosed a left atrial mass, partly due to use of echo contrast.</p> <p>Case presentation</p> <p>An 80 year-old woman was referred for transthoracic echocardiography because of one-month duration of worsening of dyspnoea. Transthoracic echocardiography displayed a large echodense mass in the left atrium. Intravenous injection of contrast (SonoVue, Bracco Inc., It) indicated contrast-enhancement of the structure, suggesting tumour. Transesophageal echocardiography revealed, however, a completely normal finding in the left atrium. Subsequent gastroscopy examination showed a hiatal hernia.</p> <p>Conclusion</p> <p>It is noteworthy that the transthoracic echocardiographic exam completely misdiagnosed what seemed like a left atrial mass, which in part was an effect of the use of echo contrast. This example highlights that liberal use of transoesophageal echocardiography is often warranted if optimal display of cardiac structures is desired.</p