Skin infection, housing and social circumstances in children living in remote Indigenous communities: testing conceptual and methodological approaches

BACKGROUND: Poor housing conditions in remote Indigenous communities in Australia are a major underlying factor in poor child health, including high rates of skin infections. The aim of this study is to test approaches to data collection, analysis and feedback for a follow-up study of the impact of housing conditions on child health. METHODS: Participation was negotiated in three communities with community councils and individual participants. Data were collected by survey of dwelling condition, interviews, and audit health centre records of children aged under seven years. Community feedback comprised immediate report of items requiring urgent repair followed by a summary descriptive report. Multivariate models were developed to calculate adjusted incidence rate ratios (IRR) for skin infections and their association with aspects of household infrastructure. RESULTS: There was a high level of participation in all communities. Health centre records were inadequate for audit in one community. The records of 138 children were available for development of multivariate analytic models. Rates of skin infection in dwellings that lacked functioning facilities for removing faeces or which had concrete floors may be up to twice as high as for other dwellings, and the latter association appears to be exacerbated by crowding. Younger children living in older dwellings may also be at approximately two-fold higher risk. A number of socioeconomic and socio-demographic variables also appear to be directly associated with high rates of skin infections. CONCLUSION: The methods used in the pilot study were generally feasible, and the analytic approach provides meaningful results. The study provides some evidence that new and modern housing is contributing to a reduction in skin infections in Aboriginal children in remote communities, particularly when this housing leads to a reduction in crowding and the effective removal of human waste

Check-Rein Technique for Management of Neglected Locked Posterior Shoulder Dislocations: Evaluation of Mid-term Outcome of a Novel Technique

Introduction: Neglected locked posterior shoulder dislocations, although rare, are quiet perplexing to manage. Various treatment methods have been explained for their management, but a consensus is still lacking. Besides describing a novel technique for the management of these lesions, this study aims to evaluate the mid-term outcome of this technique. Method: This prospective study involved seven consecutive patients with locked posterior dislocation of the shoulder with humeral defect between 25% and 50%. All patients underwent open reduction of the locked posterior dislocation with the current technique. The final outcome was assessed at a mean follow up of 3.5 years (range 2-5 years) using the DASH score. Result: The mean age of the patients was 32 years (range 21- 44) and all were men. The mean time to presentation from initial injury was 2.4 years (range 2-4 years). The patient related outcome as measured by DASH score improved from a preoperative mean of 59.1 to mean value of 8.6 at the time of final follow up. There were no cases of graft pull out, nonunion at the graft site or infection. Conclusion: This technique results in pain-free range of motion with a stable shoulder though a larger sample population with a longer follow up is required to further support our observations