Blood perfusion changes during sacral nerve root stimulation versus surface gluteus electrical stimulation on in seated spinal cord injury

Objective: To examine dynamic changes of ischial blood perfusion during sacral nerve root stimulation against surface functional electrical stimulation (FES). Methods: Fourteen adults with suprasacral complete spinal cord injury were recruited. The gluteal maximus was activated by surface FES or stimulating sacral nerve roots by functional magnetic stimulation (FMS) or a sacral anterior root stimulator implant (SARS). Ischial skin index of haemoglobin (IHB) and oxygenation (IOX) was measured. Results: Skin blood perfusion was significantly higher during FMS than the baseline (IHB 1.05±0.21 before vs. 1.08±0.02 during stimulation, P=0.03; IOX 0.18 ± 0.21 before vs. 0.46 ± 0.30, P=0.01 during stimulation, n=6). Similarly, when using the SARS implant, we also observed that blood perfusion significantly increased (IHB 1.01 ± 0.02 before vs. 1.07 ±0.02 during stimulation, P=0.003; IOX 0.79±0.81 before vs. 2.2±1.21 during stimulation, P=0.03, n=6). However, there was no significant change of blood perfusion during surface FES. Among 4 participants who completed both the FMS and FES studies, the magnitude of increase in both parameters was significantly higher during FMS. Conclusion: This study demonstrates that using SARS implant is more efficient to activate gluteal muscles and confer better benefit on blood perfusion than applying traditional FES in SCI population

Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children

Background: The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. Methods: Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. Results: Of the 751 369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49 962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0–3, 10.1% had ASN, compared with 9.1% of those scoring 4–7 and 6.6% of those scoring 7–10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. Conclusions: Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level

Apgar score and the risk of cause specific infant mortality: a population based cohort study of 1,029,207 livebirths

Background<p></p> The Apgar score has been used worldwide as an index of early neonatal condition for more than 60 years. With advances in health-care service provision, neonatal resuscitation, and infant care, its present relevance is unclear. The aim of the study was to establish the strength of the relation between Apgar score at 5 min and the risk of neonatal and infant mortality, subdivided by specific causes.<p></p> Methods<p></p> We linked routine discharge and mortality data for all births in Scotland, UK between 1992 and 2010. We restricted our analyses to singleton livebirths, in women aged over 10 years, with a gestational age at delivery between 22 and 44 weeks, and excluded deaths due to congenital anomalies or isoimmunisation. We calculated the relative risks (RRs) of neonatal and infant death of neonates with low (0–3) and intermediate (4–6) Apgar scores at 5 min referent to neonates with normal Apgar score (7–10) using binomial log-linear modelling with adjustment for confounders. Analyses were stratified by gestational age at birth because it was a significant effect modifier. Missing covariate data were imputed.<p></p> Findings<p></p> Complete data were available for 1 029 207 eligible livebirths. Across all gestational strata, low Apgar score at 5 min was associated with an increased risk of neonatal and infant death. However, the strength of the association (adjusted RR, 95% CI referent to Apgar 7–10) was strongest at term (p<0·0001). A low Apgar (0–3) was associated with an adjusted RR of 359·4 (95% CI 277·3–465·9) for early neonatal death, 30·5 (18·0–51·6) for late neonatal death, and 50·2 (42·8–59·0) for infant death. We noted similar associations of a lower magnitude for intermediate Apgar (4–6). The strongest associations were for deaths attributed to anoxia and low Apgar (0–3) for term infants (RR 961·7, 95% CI 681·3–1357·5) and preterm infants (141·7, 90·1–222·8). No association between Apgar score at 5 min and the risk of sudden infant death syndrome was noted at any gestational age (RR 0·6, 95% CI 0·1–4·6 at term; 1·2, 0·3–4·8 at preterm).<p></p> Interpretation<p></p> Low Apgar score at 5 min was strongly associated with the risk of neonatal and infant death. Our findings support its continued usefulness in contemporary practice

Syndemic contexts: findings from a review of research on non-communicable diseases and interviews with experts

Background Syndemics are characterized by the clustering of two or more health conditions, their adverse interaction, and contextual factors that create the conditions for clustering and/or interaction that worsens health outcomes. Studying syndemics entails drawing on diverse disciplines, including epidemiology and anthropology. This often means collaboration between researchers with different scholarly backgrounds, who share and – ideally – integrate their findings. Objective This article examines how context within syndemics has been defined and studied. Methods A literature review of empirical studies focusing on syndemics involving non-communicable diseases (NCDs) and mental health conditions was conducted and the full text of 13 articles was analyzed. The review was followed-up with semi-structured interviews with 11 expert researchers working in the field. Results The review and interviews highlighted a relatively consistent definition of syndemics. The reviewed studies of NCD-related syndemics tended to focus on micro-level context, suggesting a need to analyze further underlying structural factors. In their syndemics research, respondents described working with other disciplines and, although there were some challenges, welcomed greater disciplinary diversity. Methodological gaps, including a lack of mixed methods and longitudinal studies, were identified, for which further interdisciplinary collaborations would be beneficial. Conclusions NCD-related syndemics research would benefit from further analysis of structural factors and the interconnections between syndemic components across multiple levels, together with more ambitious research designs integrating quantitative and qualitative methods. Research on the COVID-19 pandemic can benefit from a syndemics approach, particularly to understand vulnerability and the unequal impacts of this public health crisis

PELATIHAN PEMBUATAN DIGESTER BIOGAS SEDERHANA BAGI KELOMPOK PKK NEFONAEK

ABSTRAKKelurahan Nefonaek merupakan salah satu kelurahan di Kota Kupang yang padat penduduknya,hal ini sudah tentu berpengaruh besar pada sampah yang dihasilkan. Karena banyaknya sampah yang dihasilkan, maka seringkali masyarakat membuang tidak pada tempatnya. Seperti yang terjadi di Jalan Supul 2, sampah - sampah dibuang oleh masyarakat di tanah kosong depan perumahan. Tujuan dari kegiatan ini adalah untuk memberikan pengetahuan tentang pengelolaan sampah rumah tangga dan praktek pembuatan digester biogas sederhana. Melalui kegiatan ini diharapkan ibu – iubu rumah tangga dapat mengolah sampah rumah tangga menggunakan digester biogas sederhana. Metode yang digunakan dalam pengabdian adalah metode ceramah, tanya jawab, diskusi, simulasi dan praktik. Hasil dari kegiatan pengabdian ini yaitu ibu – ibu kelompok PKK Nefonaek mendapat pengetahuan tentang cara mengelola sampah organik, serta dapat membuat digester biogas sederhana dengan menggunakan bahan yang ada disekitar perumahan. Kata kunci: sampah organik; pengelolaan sampah; digester biogas sederhana. ABSTRACTKelurahan Nefonaek is one of the urban villages in Kupang City which is densely populated, this of course has a big effect on the waste produced. Because of the large amount of waste generated, people often dispose of it inappropriately. As happened on Jalan Supul 2, the community discards garbage on the empty land in front of the housing. The purpose of this activity is to provide knowledge about household waste management and the practice of making a simple biogas digester. Through this activity, it is hoped that housewives can process household waste using a simple biogas digester. The methods used in the community service are lecture, question and answer, discussion, simulation, and practice methods.The results of this service were that the women of the Nefonaek PKK group got knowledge about how to manage organic waste, and were able to make a simple biogas digester using materials around the housing. Keywords: organic waste; waste management; a simple biogas digester