Misdiagnosis, Mistreatment, and Harm - When Medical Care Ignores Social Forces.

The Case Studies in Social Medicine demonstrate that when physicians use only biologic or individual behavioral interventions to treat diseases that stem from or are exacerbated by social factors, we risk harming the patients we seek to serve

Heart rate variability: Linear and non-linear analysis of pre-awake period for normal and intrauterine growth restricted children at 10 year

Non-optimal fetal growth has been associated with an increased risk of coronary heart diseases in later life. Heart rate variability (HRV) is a non-invasive method reflecting autonomic cardiac function and decreased heart rate variability has been associated with arrhythmic complications in humans. This study compares the result of linear and nonlinear HRV measures performed in long term (24 h) versus short term (15 min before awakening) interbeat interval time series data of normal and growth restricted children who were 9-10 years old. The aim of the study was to investigate which HRV measures obtained from short term recording reliably reflect information provided by long term recording. The comparability of HRV parameters derived from long term and short term recordings showed that low birth weight growth restricted children (IUGR) have low HRV. The findings indicated that low birth weight in growth retarded may be associated with negative cardiovascular outcome

Building the genomic nation: ‘Homo Brasilis’ and the ‘Genoma Mexicano’ in comparative cultural perspective

This article explores the relationship between genetic research, nationalism and the construction of collective social identities in Latin America. It makes a comparative analysis of two research projects – the ‘Genoma Mexicano’ and the ‘Homo Brasilis’ – both of which sought to establish national and genetic profiles. Both have reproduced and strengthened the idea of their respective nations of focus, incorporating biological elements into debates on social identities. Also, both have placed the unifying figure of the mestizo/mestiço at the heart of national identity constructions, and in so doing have displaced alternative identity categories, such as those based on race. However, having been developed in different national contexts, these projects have had distinct scientific and social trajectories: in Mexico, the genomic mestizo is mobilized mainly in relation to health, while in Brazil the key arena is that of race. We show the importance of the nation as a frame for mobilizing genetic data in public policy debates, and demonstrate how race comes in and out of focus in different Latin American national contexts of genomic research, while never completely disappearing

Identifying the need for good practices in Health Technology Assessment : summary of the ISPOR HTA Council Working Group Report on Good Practices in HTA

The systematic use of evidence to inform healthcare decisions, particularly health technology assessment (HTA), has gained increased recognition. HTA has become a standard policy tool for informing decision makers who must manage the entry and use of pharmaceuticals, medical devices, and other technologies (including complex interventions) within health systems, for example, through reimbursement and pricing. Despite increasing attention to HTA activities, there has been no attempt to comprehensively synthesize good practices or emerging good practices to support populationbased decision-making in recent years. After the identification of some good practices through the release of the ISPOR Guidelines Index in 2013, the ISPOR HTA Council identified a need to more thoroughly review existing guidance. The purpose of this effort was to create a basis for capacity building, education, and improved consistency in approaches to HTA-informed decision-making. Our findings suggest that although many good practices have been developed in areas of assessment and some other key aspects of defining HTA processes, there are also many areas where good practices are lacking. This includes good practices in defining the organizational aspects of HTA, the use of deliberative processes, and measuring the impact of HTA. The extent to which these good practices are used and applied by HTA bodies is beyond the scope of this report, but may be of interest to future researchers

Heart rate variability in low birth weight growth restricted children during sleep and wake stages

Poor fetal growth may alter the regularity mechanism of cardiac autonomic system that is involved in the development of these diseases. The malfunctioning of the cardiac autonomic system assessed by decrease in heart rate variability (HRV) is associated with negative cardiovascular outcomes. This study is aimed at investigating the risk of development of coronary heart disease in IUGR children in later life. For that purpose HRV analysis of normal and growth restricted children was performed during sleep and wake stages. The study group consisted of 9 to 10 years old, 32 normal, 20 low birth weight IUGR children. The standard time domain HRV metrics (mean RR, SDNN, RMSSD, NN50 and pNN50) and Poincaré indices (SD1 and SD2) were used to analyse and compare the RR-interval time series of these groups. The IUGR children showed lower HRV as compared with normal children during both sleep and wake stages. The significantly decreased HRV during sleep provide an evidence of autonomic derangement that may be associated with higher risk of lethal arrhythmias in the IUGR children in later life

The HubBLe trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for haemorrhoids

BACKGROUND:Haemorrhoids (piles) are a very common condition seen in surgical clinics. After exclusion of more sinister causes of haemorrhoidal symptoms (rectal bleeding, perianal irritation and prolapse), the best option for treatment depends upon persistence and severity of the symptoms. Minor symptoms often respond to conservative treatment such as dietary fibre and reassurance. For more severe symptoms treatment such as rubber band ligation may be therapeutic and is a very commonly performed procedure in the surgical outpatient setting. Surgery is usually reserved for those who have more severe symptoms, as well as those who do not respond to non-operative therapy; surgical techniques include haemorrhoidectomy and haemorrhoidopexy. More recently, haemorrhoidal artery ligation has been introduced as a minimally invasive, non destructive surgical option.There are substantial data in the literature concerning efficacy and safety of ’rubber band ligation including multiple comparisons with other interventions, though there are no studies comparing it to haemorrhoidal artery ligation. A recent overview has been carried out by the National Institute for Health and Clinical Excellence which concludes that current evidence shows haemorrhoidal artery ligation to be a safe alternative to haemorrhoidectomy and haemorrhoidopexy though it also highlights the lack of good quality data as evidence for the advantages of the technique. METHODS/DESIGN:The aim of this study is to establish the clinical effectiveness and cost effectiveness of haemorrhoidal artery ligation compared with conventional rubber band ligation in the treatment of people with symptomatic second or third degree (Grade II or Grade III) haemorrhoids.Design: A multi-centre, parallel group randomised controlled trial.Outcomes: The primary outcome is patient-reported symptom recurrence twelve months following the intervention. Secondary outcome measures relate to symptoms, complications, health resource use, health related quality of life and cost effectiveness following the intervention.Participants: 350 patients with grade II or grade III haemorrhoids will be recruited in surgical departments in up to 14 NHS hospitals.Randomisation: A multi-centre, parallel group randomised controlled trial. Block randomisation by centre will be used, with 175 participants randomised to each group. DISCUSSION:The results of the research will help inform future practice for the treatment of grade II and III haemorrhoids.TRIAL REGISTRATION:ISRCTN4139471