The Diagnostic Process of Spinal Post-Traumatic Deformity: An Expert Survey of 7 Cases, Consensus on Clinical Relevance Does Exist

STUDY DESIGN: Survey of cases. OBJECTIVE: To evaluate the opinion of experts in the diagnostic process of clinically relevant Spinal Post-traumatic Deformity (SPTD). SUMMARY OF BACKGROUND DATA: SPTD is a potential complication of spine trauma that can cause decreased function and quality of life impairment. The question of when SPTD becomes clinically relevant is yet to be resolved. METHODS: The survey of 7 cases was sent to 31 experts. The case presentation was medical history, diagnostic assessment, evaluation of diagnostic assessment, diagnosis, and treatment options. Means, ranges, percentages of participants, and descriptive statistics were calculated. RESULTS: Seventeen spinal surgeons reviewed the presented cases. The items\u27 fracture type and complaints were rated by the participants as more important, but no agreement existed on the items of medical history. In patients with possible SPTD in the cervical spine (C) area, participants requested a conventional radiograph (CR) (76%-83%), a flexion/extension CR (61%-71%), a computed tomography (CT)-scan (76%-89%), and a magnetic resonance (MR)-scan (89%-94%). In thoracolumbar spine (ThL) cases, full spine CR (89%-100%), CT scan (72%-94%), and MR scan (65%-94%) were requested most often. There was a consensus on 5 out of 7 cases with clinically relevant SPTD (82%-100%). When consensus existed on the diagnosis of SPTD, there was a consensus on the case being compensated or decompensated and being symptomatic or asymptomatic. CONCLUSIONS: There was strong agreement in 5 out of 7 cases on the presence of the diagnosis of clinically relevant SPTD. Among spine experts, there is a strong consensus to use CT scan and MR scan, a cervical CR for C-cases, and a full spine CR for ThL-cases. The lack of agreement on items of the medical history suggests that a Delphi study can help us reach a consensus on the essential items of clinically relevant SPTD. LEVEL OF EVIDENCE: Level V

Screening for Adverse Childhood Experiences (ACEs) before age 3: Evidence for the Family Map Inventory

This study examined a web-based assessment of adverse childhood experiences (eFMI-ACE) of children birth to 3 years-of-age using the Family Map Inventory (FMI-ACE) conducted by early childhood education (ECE) program staff. The paper version of FMI-ACE (pFMI-ACE) is a validated tool to screen ACEs among children birth to 5 years-of-age enrolled in home visiting programs. In this study, parents of children (N=1,591) enrolled in Early Head Start (EHS) between August 2018 and July 2020 were interviewed using the electronically formatted Family Map Inventory (FMI). The EHS providers interviewed parents through the FMI online system as part of their program family assessments. Analyses mirrored the pFMI-ACE validation study to confirm the fidelity of electric assessment of the FMI-ACE (eFMI-ACE). Further analyses examined the change in the eFMI-ACE responses in programs that interviewed families twice during EHS program participation. The eFMI-ACE score, like the validation study, was negatively associated with parental warmth and had a similar distribution. After a minimum 90 days of EHS services (M = 186, SD = 60; range 91-448), eFMI-ACE scores were statistically significantly reduced. The family-friendly screen for risk of ACEs functions similarly in electronic and paper administration and for children birth to 3 years-of-age. It showed small but statistically significant reductions after EHS services

Engaging Families and Addressing Adverse Childhood Experiences in Early Head Start

Supporting parenting and home environments for children through collaborations with families is a critical function of Early Head Start (EHS)/Head Start (HS) providers. Building a strong partnership with caregivers allows educators to identify family strengths and identifying areas of concern in parenting and home environments, such as those linked to adverse childhood experiences (ACEs). Family Map Inventory (FMI) is a tool used to screen for ACEs among children birth to 5 years-of-age while respecting the family needs. The effectiveness of FMI in its original paper format (p-FMI) has been validated. This study examined the validity of a new, web-based Family Map Inventory (e-FMI) by (1) comparing the distribution of ACEs risks captured in e-FMI with the traditional p-FMI, and (2) investigating the association of ACEs captured through e-FMI and parental warmth. Further, this study documented decreases in ACEs risks after center-based EHS services

Sex-based differences in rates, causes, and predictors of death among injection drug users in Vancouver, Canada

In the present study, we sought to identify rates, causes, and predictors of death among male and female injection drug users (IDUs) in Vancouver, British Columbia, Canada, during a period of expanded public health interventions. Data from prospective cohorts of IDUs in Vancouver were linked to the provincial database of vital statistics to ascertain rates and causes of death between 1996 and 2011. Mortality rates were analyzed using Poisson regression and indirect standardization. Predictors of mortality were identified using multivariable Cox regression models stratified by sex. Among the 2,317 participants, 794 (34.3%) of whom were women, there were 483 deaths during follow-up, with a rate of 32.1 (95% confidence interval (CI): 29.3, 35.0) deaths per 1,000 person-years. Standardized mortality ratios were 7.28 (95% CI: 6.50, 8.14) for men and 15.56 (95% CI: 13.31, 18.07) for women. During the study period, mortality rates related to infection with human immunodeficiency virus (HIV) declined among men but remained stable among women. In multivariable analyses, HIV seropositivity was independently associated with mortality in both sexes (all P < 0.05). The excess mortality burden among IDUs in our cohorts was primarily attributable to HIV infection; compared with men, women remained at higher risk of HIV-related mortality, indicating a need for sex-specific interventions to reduce mortality among female IDUs in this setting.Medicine, Faculty ofOther UBCNon UBCMedicine, Department ofReviewedFacultyResearche

Blackouts and Progress: Privatization, Infrastructure, and a Developmentalist State in Jimma, Ethiopia

Uncorrected proof. Supplemental material: http://culanth.org/?q=node/475The recent completion of a hydropower dam near Jimma, Ethiopia coincided with rolling blackouts throughout the country and accusations of corruption and mismanagement being directed toward the Ethiopian government and the Italian company that constructed the dam. The case appears to be one more example of an African state failing to provide its citizens with basic public services in a context of neoliberal economic restructuring. Recent road construction and urban renewal projects in Jimma have also been contracted out to private companies and have led to displaced families and disruptions of day-to-day life. Jimma residents, however, have generally met these projects with statements of approval and appreciation for the power of the Ethiopian state to bring progress. In this article, I examine contrasting narratives concerning privatized infrastructural development projects. I argue that although the provision of basic services is increasingly contracted out to private companies, the perceived presence of the Ethiopian state has expanded in new and surprising ways. Contrasting perceptions of dams and road construction are based in values concerning relations of power and exchange. In this case, the particular relationship between the privatization of infrastructure and perceptions of the state demonstrates the limits of neoliberalism as an analytical category. I argue that in recent anthropological scholarship a reliance on neoliberalism as a category of analysis obscures more than it reveals, and I call for more attention to correlations between specific techniques of governance and relations of power.National Science Foundation Grant #0717608; Fulbright-Hays Fellowshi

No association between HIV status and risk of non-fatal overdose among people who inject drugs in Vancouver, Canada

Background: The evidence to date on whether HIV infection increases the risk of accidental drug overdose among people who inject drugs (PWID) is equivocal. Thus, we sought to estimate the effect of HIV infection on risk of non-fatal overdose among two parallel cohorts of HIV-positive and –negative PWID. Methods: Data were collected from a prospective cohort of PWID in Vancouver, Canada between 2006 and 2013. During biannual follow-up assessments, non-fatal overdose within the previous 6 months was assessed. Bivariable and multivariable generalized mixed-effects regression models were used to determine the unadjusted and adjusted associations between HIV status, plasma HIV-1 RNA viral load, and likelihood of non-fatal overdose. Results: A total of 1760 eligible participants (67% male, median age = 42, and 42% HIV-positive at baseline) were included. Among 15,070 unique observations, 649 (4.3%) included a report of a non-fatal overdose within the previous 6 months (4.4% among seropositive and 4.3% among seronegative individuals). We did not observe a difference in the likelihood of overdose by HIV serostatus in crude (odds ratio [OR]: 1.05, p = 0.853) analyses or analyses adjusted for known overdose risk factors (adjusted OR [AOR]: 1.19, p = 0.474). In a secondary analysis, among HIV-positive PWID, we did not observe an association between having a detectable viral load and overdose (AOR: 1.03, p = 0.862). Conclusions: Despite the evidence that HIV infection is a risk factor for fatal overdose, we found no evidence for a relationship between HIV disease and non-fatal overdose. However, overdose remains high among PWID, indicating the need for ongoing policy addressing this problem, and research into understanding modifiable risk factors that predict non-fatal overdose.Medicine, Faculty ofOther UBCNon UBCMedicine, Department ofReviewedFacultyResearcherPostdoctora

The Diagnostic Process of Spinal Post-traumatic Deformity : An Expert Survey of 7 Cases, Consensus on Clinical Relevance Does Exist

Study Design: Survey of cases. Objective: To evaluate the opinion of experts in the diagnostic process of clinically relevant Spinal Post-traumatic Deformity (SPTD). Summary of Background Data: SPTD is a potential complication of spine trauma that can cause decreased function and quality of life impairment. The question of when SPTD becomes clinically relevant is yet to be resolved. Methods: The survey of 7 cases was sent to 31 experts. The case presentation was medical history, diagnostic assessment, evaluation of diagnostic assessment, diagnosis, and treatment options. Means, ranges, percentages of participants, and descriptive statistics were calculated. Results: Seventeen spinal surgeons reviewed the presented cases. The items' fracture type and complaints were rated by the participants as more important, but no agreement existed on the items of medical history. In patients with possible SPTD in the cervical spine (C) area, participants requested a conventional radiograph (CR) (76%-83%), a flexion/extension CR (61%-71%), a computed tomography (CT)-scan (76%-89%), and a magnetic resonance (MR)-scan (89%-94%). In thoracolumbar spine (ThL) cases, full spine CR (89%-100%), CT scan (72%-94%), and MR scan (65%-94%) were requested most often. There was a consensus on 5 out of 7 cases with clinically relevant SPTD (82%-100%). When consensus existed on the diagnosis of SPTD, there was a consensus on the case being compensated or decompensated and being symptomatic or asymptomatic. Conclusions: There was strong agreement in 5 out of 7 cases on the presence of the diagnosis of clinically relevant SPTD. Among spine experts, there is a strong consensus to use CT scan and MR scan, a cervical CR for C-cases, and a full spine CR for ThL-cases. The lack of agreement on items of the medical history suggests that a Delphi study can help us reach a consensus on the essential items of clinically relevant SPTD.Peer reviewe