Increasing Short-Stay Unplanned Hospital Admissions among Children in England; Time Trends Analysis '97-'06

BACKGROUND: Timely care by general practitioners in the community keeps children out of hospital and provides better continuity of care. Yet in the UK, access to primary care has diminished since 2004 when changes in general practitioners' contracts enabled them to 'opt out' of providing out-of-hours care and since then unplanned pediatric hospital admission rates have escalated, particularly through emergency departments. We hypothesised that any increase in isolated short stay admissions for childhood illness might reflect failure to manage these cases in the community over a 10 year period spanning these changes. METHODS AND FINDINGS: We conducted a population based time trends study of major causes of hospital admission in children 2 days. By 2006, 67.3% of all unplanned admissions were isolated short stays <2 days. The increases in admission rates were greater for common non-infectious than infectious causes of admissions. CONCLUSIONS: Short stay unplanned hospital admission rates in young children in England have increased substantially in recent years and are not accounted for by reductions in length of in-hospital stay. The majority are isolated short stay admissions for minor illness episodes that could be better managed by primary care in the community and may be evidence of a failure of primary care services

Books

Current Ocular Therapy. Ed. by F. T. Fraunfelder, F. Hampton Roy and S. Martha Meyer. Pp. xiii + 792. Illustrated. £55. Nonhmead: WB Saunders. 1989.Dysfunctional Uterine Bleeding and Menorrhagia. Bailliere's Clinical Obstetrics and Gynaecolcgy: International Practice and Research, June 1989. Ed. by J. O. Drife. Pp. 217 + 428. Illustrated. £18,50. Northmead: WE Saunders.1989.Treatment of Cancer. 2nd ed. Ed. by Karol Sikora and Keith E. Halnan. Pp. ix + 916. Illustrated. Price £99,50. London: Chapman and Hall Medical. 1990.Ocular Syndromes and Systemic Diseases. 2nd edition. Ed. by F. Hampton Roy. Pp. xlvii + 470. £40. Northmead: WE Saunders. 1989.Non-invasive Cardiac Imaging. British Medical Bulletin. Vol. 45, No. 4. Ed. by D. G. Gibson. Pp. 830 + 1109. Illustrated. £25 (UK) or £31,50 (overseas). New York: Churchill Livingstone. 1989.Laparoscopic Surgery. Bailliere's Clinical Obstetrics and Gynaecology: International Practice and Research, September 1989. Ed. by C. J. G. Sunon. Pp. 429 + 686. Illustrated. £18,50. Northmead: WB Saunders. 1989.Management ofMinor Head Injuries. Ed. by I. J. Swann and D. W. Yates. Pp. x + 102. Illustrated: £14,95. Hampshire: Chapman &amp; Hall Medical. 1989.ABC of Child Abuse. Ed. by Roy Meadow. Pp. 59. Illustrated. London: BMJ. 1989.The Facts of Life. Ed. by Marina Petropulos. Pp. 1 + 222. Illustrated. R19,95 exc!. GST. Cape Town: Tafelberg. 1990.Physical Examination of the Heart and Circulation. 2nd ed. Ed. by Joseph K. Perloff. Pp. viii + 292. Illustrated. £17,95. Northmead: WB Saunders. 1989.Growth Regulation of Thyroid Gland and Thyroid Tumours: Frontiers ofHormone Research. Vo!. 18. Ed. by P. E. Goretzki, and H. D. Roher. Pp. viii + 163. Illustrated. £68,80. Basel: S. Karger. 1989.Topical Diagnosis in Neurology: Anatomy, Physiology, Signs, Symptoms. 2nd revised ed. Ed. by P. Duus. Pp. x + 337. Illustrated. DM 370. Stungart: Georg Thieme Verlag. 1989

Adverse health effects of low levels of perceived control in Swedish and Russian community samples

Background: This cross-sectional study of two middle-aged community samples from Sweden and Russia examined the distribution of perceived control scores in the two populations, investigated differences in individual control items between the populations, and assessed the association between perceived control and self-rated health. Methods: The samples consisted of men and women aged 45–69 years, randomly selected from national and local population registers in southeast Sweden (n = 1007) and in Novosibirsk, Russia (n = 9231). Data were collected by structured questionnaires and clinical measures at a visit to a clinic. The questionnaire covered socioeconomic and lifestyle factors, societal circumstances, and psychosocial measures. Self-rated health was assessed by standard single question with five possible answers, with a cut-off point at the top two alternatives. Results: 32.2 % of Swedish men and women reported good health, compared to 10.3 % of Russian men and women. Levels of perceived control were also significantly lower in Russia than in Sweden and varied by socio-demographic parameters in both populations. Sub-item analysis of the control questionnaire revealed substantial differences between the populations both in the perception of control over life and over health. Logistic regression analysis revealed that the odds ratios (OR) of poor self-rated health were significantly increased in men and women with low perceived control in both countries (OR between 2.61 and 4.26). Conclusion: Although the cross-sectional design does not allow causal inference, these results support the view that perceived control influences health, and that it may mediate the link between socioeconomic hardship and health

Giant serous cystadenoma arising from an accessory ovary in a morbidly obese 11-year-old girl: a case report

<p>Abstract</p> <p>Introduction</p> <p>Ectopic ovarian tissue is an unusual entity, especially if it is an isolated finding thought to be of embryological origin.</p> <p>Case presentation</p> <p>An 11-year-old, morbidly obese female presented with left flank pain, nausea, and irregular menses. Various diagnostic procedures suggested a large ovarian cyst, and surgical resection was performed.</p> <p>Conclusion</p> <p>Histologically, the resected mass was not of tubal origin as suspected, but a serous cystadenoma arising from ovarian tissue. The patient's two normal, eutopic ovaries were completely uninvolved and unaffected. A tumor arising from ectopic ovarian tissue of embryological origin seems the most likely explanation. We suggest refining the descriptive nomenclature so as to more precisely characterize the various presentations of ovarian ectopia.</p

Spinal involvement in mucopolysaccharidosis IVA (Morquio-Brailsford or Morquio A syndrome): presentation, diagnosis and management.

Mucopolysaccharidosis IVA (MPS IVA), also known as Morquio-Brailsford or Morquio A syndrome, is a lysosomal storage disorder caused by a deficiency of the enzyme N-acetyl-galactosamine-6-sulphate sulphatase (GALNS). MPS IVA is multisystemic but manifests primarily as a progressive skeletal dysplasia. Spinal involvement is a major cause of morbidity and mortality in MPS IVA. Early diagnosis and timely treatment of problems involving the spine are critical in preventing or arresting neurological deterioration and loss of function. This review details the spinal manifestations of MPS IVA and describes the tools used to diagnose and monitor spinal involvement. The relative utility of radiography, computed tomography (CT) and magnetic resonance imaging (MRI) for the evaluation of cervical spine instability, stenosis, and cord compression is discussed. Surgical interventions, anaesthetic considerations, and the use of neurophysiological monitoring during procedures performed under general anaesthesia are reviewed. Recommendations for regular radiological imaging and neurologic assessments are presented, and the need for a more standardized approach for evaluating and managing spinal involvement in MPS IVA is addressed

How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men?

BACKGROUND: Falls affect approximately one third of community-dwelling older adults each year and have serious health and social consequences. Fear of falling (FOF) (lack of confidence in maintaining balance during normal activities) affects many older adults, irrespective of whether they have actually experienced falls. Both falls and fear of falls may result in restrictions of physical activity, which in turn have health consequences. To date the relation between (i) falls and (ii) fear of falling with physical activity have not been investigated using objectively measured activity data which permits examination of different intensities of activity and sedentary behaviour. METHODS: Cross-sectional study of 1680 men aged 71-92 years recruited from primary care practices who were part of an on-going population-based cohort. Men reported falls history in previous 12 months, FOF, health status and demographic characteristics. Men wore a GT3x accelerometer over the hip for 7 days. RESULTS: Among the 12% of men who had recurrent falls, daily activity levels were lower than among non-fallers; 942 (95% CI 503, 1381) fewer steps/day, 12(95% CI 2, 22) minutes less in light activity, 10(95% CI 5, 15) minutes less in moderate to vigorous PA [MVPA] and 22(95% CI 9, 35) minutes more in sedentary behaviour. 16% (n = 254) of men reported FOF, of whom 52% (n = 133) had fallen in the past year. Physical activity deficits were even greater in the men who reported that they were fearful of falling than in men who had fallen. Men who were fearful of falling took 1766(95% CI 1391, 2142) fewer steps/day than men who were not fearful, and spent 27(95% CI 18, 36) minutes less in light PA, 18(95% CI 13, 22) minutes less in MVPA, and 45(95% CI 34, 56) minutes more in sedentary behaviour. The significant differences in activity levels between (i) fallers and non-fallers and (ii) men who were fearful of falling or not fearful, were mediated by similar variables; lower exercise self-efficacy, fewer excursions from home and more mobility difficulties. CONCLUSIONS: Falls and in particular fear of falling are important barriers to older people gaining health benefits of walking and MVPA. Future studies should assess the longitudinal associations between falls and physical activity

DNA methylation and mRNA expression of SYN III, a candidate gene for schizophrenia

<p>Abstract</p> <p>Background</p> <p>The synapsin III (<it>SYN III</it>) gene on chromosome 22q is a candidate gene for schizophrenia susceptibility due to its chromosome location, neurological function, expression patterns and functional polymorphisms.</p> <p>Methods</p> <p>This research has established the mRNA expression of <it>SYN III </it>in 22 adult human brain regions as well as the methylation specificity in the closest CpG island of this gene. The methylation specificity studied in 31 brain regions (from a single individual) was also assessed in 51 human blood samples (representing 20 people affected with schizophrenia and 31 normal controls) including a pair of monozygotic twin discordant for schizophrenia and 2 non-human primates.</p> <p>Results</p> <p>The results show that the cytosine methylation in this genomic region is 1) restricted to cytosines in CpG dinucleotides 2) similar in brain regions and blood and 3) appears conserved in primate evolution. Two cytosines (cytosine 8 and 20) localized as the CpG dinucleotide are partially methylated in all brain regions studied. The methylation of these sites in schizophrenia and control blood samples was variable. While cytosine 8 was partially methylated in all samples, the distribution of partial to complete methylation at the cytosine 20 was 22:9 in controls as compared to 18:2 in schizophrenia (p = 0.82). Also, there is no difference in methylation between the affected and unaffected member of a monozygotic twin pair.</p> <p>Conclusion</p> <p>The variation in <it>SYN III </it>methylation studied is 1) not related to schizophrenia in the population sample or a monozygotic twin pair discordant for schizophrenia and 2) not related to the mRNA level of <it>SYN IIIa </it>in different human brain regions.</p

Disentangling the sources of ionizing radiation in superconducting qubits

Radioactivity was recently discovered as a source of decoherence and correlated errors for the real-world implementation of superconducting quantum processors. In this work, we measure levels of radioactivity present in a typical laboratory environment (from muons, neutrons, and γ-rays emitted by naturally occurring radioactive isotopes) and in the most commonly used materials for the assembly and operation of state-of-the-art superconducting qubits. We present a GEANT-4 based simulation to predict the rate of impacts and the amount of energy released in a qubit chip from each of the mentioned sources. We finally propose mitigation strategies for the operation of next-generation qubits in a radio-pure environment