Functional outcome of patients with spinal cord injury: rehabilitation outcome study

Objective: To increase our knowledge of neurological recovery and functional outcome of patients with spinal cord injuries in order to make more successful rehabilitation programmes based on realistic goals.Design: Descriptive analysis of data gathered in an information system.Setting: Rehabilitation centre in The Netherlands with special department for patients with spinal cord injuries.Subjects: Fifty-five patients with traumatic spinal cord lesions admitted to the rehabilitation centre from 1988 to 1994. Main outcome measures: The functional improvement was presented in terms of progress in independence in nine daily activity skills. Independence was rated on a four-point scale.Results: From admission to discharge, lesions in 100% of patients with tetraplegia and 96% of patients with paraplegia remained complete. Significant progress in independence was made in self-care, ambulation and bladder and bowel care. Differences were found in the extent of functional improvement between subgroups of patients with different levels and extent of lesion. Contrary to expectations based on theoretical models, patients with complete paraplegia did not achieve maximal independence in self-care. Independent walking was only attained by patients with incomplete lesions. Regarding outcome of bladder and bowel care, poor results were found, especially the independence in defaecation and toilet transfers.Conclusions: The results of this study provided more insight into the functional outcome of a group of patients with traumatic spinal cord injury. More research is needed to evaluate the rehabilitation programmes for these patients

A Structural Parametrization of the Brain Using Hidden Markov Models Based Paths in Alzheimer's Disease

The usage of biomedical imaging in the diagnosis of dementia is increasingly widespread. A number of works explore the possibilities of computational techniques and algorithms in what is called Computed Aided Diagnosis. Our work presents an automatic parametrization of the brain structure by means of a path generation algorithm based on Hidden Markov Models. The path is traced using information of intensity and spatial orientation in each node, adapting to the structural changes of the brain. Each path is itself a useful way to extract features from the MRI image, being the intensity levels at each node the most straightforward. However, a further processing consisting of a modification of the Gray Level Co-occurrence Matrix can be used to characterize the textural changes that occur throughout the path, yielding more meaningful values that could be associated to the structural changes in Alzheimer's Disease, as well as providing a significant feature reduction. This methodology achieves high performance, up to 80.3\% of accuracy using a single path in differential diagnosis involving Alzheimer-affected subjects versus controls belonging to the Alzheimer's Disease Neuroimaging Initiative (ADNI).TIC218, MINECO TEC2008-02113 and TEC2012-34306 projects, Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía P09-TIC-4530 and P11-TIC-71

Anthropology, Brokerage and Collaboration in the development of a Tongan Public Psychiatry: Local Lessons for Global Mental Health

The Global Mental Health (GMH) movement has revitalised questions of the translatability of psychiatric concepts and the challenges of community engagement in countries where knowledge of the biomedical basis for psychiatric diagnosis is limited or challenged by local cultural codes. In Tonga, the local psychiatrist Dr Puloka has successfully established a publicly accessible psychiatry that has raised admission rates for serious mental illness and addressed some of the stigma attached to diagnosis. On the basis of historical analysis and ethnographic fieldwork with healers, doctors and patients since 1998, this article offers an ethnographic contextualization of the development and reception of three key interventions during the 1990s inspired by traditional healing and reliant on the translation of psychiatric terms and diagnosis. Dr Puloka’s use of medical anthropological and transcultural psychiatry research informed a community engaged brokerage between the implications of psychiatric nosologies and local needs. As such it reveals deficiencies in current polarised positions on the GMH project and offers suggestions to address current challenges of the Global Mental Health movement

Measuring the symptomatic, physical, emotional and social impacts of dry mouth: A qualitative study

Objective To explore the impacts of dry mouth in order to develop a comprehensive condition‐specific OHRQoL measure. Background Dry mouth has been shown to have significant, if not more severe impacts on OHRQoL, than dental caries. Yet there remain few studies reporting on how to develop a comprehensive measure of the impact of dry mouth on OHRQoL. Methods This study was a qualitative study using semi‐structured interviews. Data were collected from a purposive sample of 17 people with dry mouth (14 women, three men). The sample was drawn to capture a comprehensive range of impacts of dry mouth. These interviews were analysed using a framework approach informed by existing functionalist approaches to OHRQoL. Results Participants reported a huge range of symptoms associated with perceived dry mouth resulting in extensive impacts on physical, emotional (psychological) and social functioning. Dry mouth could also result in restrictions in social participation which, under some conditions, could be disabling. These impacts were modified by psychological, social and environmental factors. Conclusions If we are to measure the impacts of oral conditions, it is important that this is done systematically and with reference to existing conceptual models of health. Current measures of the impact of dry mouth cover symptoms, discomfort and physical impacts along with some aspects of how people cope with the condition. This study proposes a more comprehensive approach that includes the full range of impacts people experience. Such an approach may enable us to focus on “downstream” and “upstream” interventions for dry mouth

Saliva-based colorimetric test as an index of gingival inflammation in epidemiologic studies

– There is a pressing need for a reliable, low-cost method of assessing the gingival and periodontal status of large population groups. Existing indexes, despite their value in dental public health, are still too subject to examiner variability for use by uncalibrated examiners. This study describes an evaluation of a quick, inexpensive, extraoral colorimetric test for gingival inflammation, based on a reaction between saliva and the test material. It could probably be applied by non-professional personnel. In this study, the test was applied to a population of elementary schoolchildren, denial hygiene students and faculty, and adult inmates of two correctional institutions. These populations were chosen on the assumption that they would exhibit varying intensities of gingival inflammation. Values obtained from the colorimetric test carried out by one researcher were compared with Gingival Index (GI) scores observed by a different examiner. Results suggest that the colorimetric test may be a valid, reliable means of detecting major differences in the prevalence of gingival inflammation in most adult populations, although having little, if any, useful application among children at the mixed dentition stage.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73489/1/j.1600-0528.1978.tb01169.x.pd

High maternal mortality estimated by the sisterhood method in a rural area of Mali

<p>Abstract</p> <p>Background</p> <p>Maternal mortality is high in Mali. Nevertheless, there are few studies on this topic from rural areas, and current estimates are mostly based on studies from urban settings. Our objective was to estimate the maternal mortality ratio in Kita, rural Mali.</p> <p>Methods</p> <p>Using the "sisterhood method", we interviewed participants aged 15-50 years from 20 villages in Kita, Mali, and thereby created a retrospective cohort of their sisters in reproductive age. Based on population and fertility estimates, we calculated the lifetime risk of maternal death, and from that the estimated approximate maternal mortality ratio.</p> <p>Results</p> <p>The 2,039 respondents reported 4,628 sisters who had reached reproductive age. Of these 4,628 sisters, almost a third (1,233; 27%) had died, and 429 (9%) had died during pregnancy or childbirth. This corresponded to a lifetime risk of maternal death of 20% and a maternal mortality ratio of 3,131 per 100,000 live births (95% confidence interval 2,967-3,296), with a time reference around 1999.</p> <p>Conclusions</p> <p>We found a very high maternal mortality in rural Mali and this highlights the urgent need for obstetric services in the remote rural areas.</p

Intoxicating entertainment? The influence of "Star Music Trek" on the drinking practices of Nigerian students

Sophisticated marketing strategies are increasingly used by transnational alcohol companies in Nigeria. While this facilitates alcohol availability and encourages alcohol consumption, there are no effective policies to regulate alcohol marketing. This study draws on qualitative interviews with 31 Nigerian university students (aged 19–23 years) to explore some of the ways in which “Star Music Trek” (SMT, a brewer-sponsored music concert) establishes spaces that facilitate alcohol consumption among Nigerian youths. The data were analyzed to generate themes with the aid of NVivo 10 software. The article argues that although the rationale for attending the SMT event is to be entertained by famous artists for a reduced entrance fee, the event creates conditions that influence young people to use alcohol in diverse ways. Among nondrinkers, SMT establishes conditions that influence alcohol initiation because purchasing “Star beer,” the brand that sponsors SMT, not only serves as a ticket or gate pass to some of the concerts, but it is also the only brand sold at the event. Among those who use alcohol, SMT creates spaces that encourage a culture of intoxication because of the easy availability and accessibility of Star beer and promotional activities in the form of price reductions, raffle draws, and free drinks. The participants also discussed the ways in which the sponsor uses its marketing representatives to promote brand allegiance by encouraging attendees to favor Star beer after the concert. Overall, the findings reveal that SMT is a sophisticated marketing strategy to promote the Star brand. The study discusses the implications of the findings and concludes that effective national alcohol control policies should be formulated and implemented in Nigeria.The doctoral research, from which this article was taken was funded by the Tertiary Education Trust Fund (TETFUND)

Bayesian Inference in Processing Experimental Data: Principles and Basic Applications

This report introduces general ideas and some basic methods of the Bayesian probability theory applied to physics measurements. Our aim is to make the reader familiar, through examples rather than rigorous formalism, with concepts such as: model comparison (including the automatic Ockham's Razor filter provided by the Bayesian approach); parametric inference; quantification of the uncertainty about the value of physical quantities, also taking into account systematic effects; role of marginalization; posterior characterization; predictive distributions; hierarchical modelling and hyperparameters; Gaussian approximation of the posterior and recovery of conventional methods, especially maximum likelihood and chi-square fits under well defined conditions; conjugate priors, transformation invariance and maximum entropy motivated priors; Monte Carlo estimates of expectation, including a short introduction to Markov Chain Monte Carlo methods.Comment: 40 pages, 2 figures, invited paper for Reports on Progress in Physic

`Whose Shoes?` Can an educational board game engage Ugandan men in pregnancy and childbirth?

Background Men can play a significant role in reducing maternal morbidity and mortality in low-income countries. Maternal health programmes are increasingly looking for innovative interventions to engage men to help improve health outcomes for pregnant women. Educational board games offer a unique approach to present health information where learning is reinforced through group discussions supporting peer-to-peer interactions. Methods A qualitative study with men from Uganda currently living in the UK on their views of an educational board game. Men were purposively sampled to play a board game and participate in a focus group discussion. The pilot study explored perceptions on whether a board game was relevant as a health promotional tool in maternal health prior to implementation in Uganda. Results The results of the pilot study were promising; participants reported the use of visual aids and messages were easy to understand and enhanced change in perspective. Men in this study were receptive on the use of board games as a health promotional tool and recommended its use in rural Uganda. Conclusions This study provides preliminary data on the relevancy and efficacy of using board games in maternal health. Key messages from the focus group appeared to be that the board game is more than acceptable to fathers and that it needs to be adapted to the local context to make it suitable for men in rural Uganda

Мастерство педагогического труда и мотивация учебной деятельности у студентов

Aim To gain insight into community nurses' experiences and how they make sense of the expertise they offer in their role Background Globally, the spotlight is currently on community nursing expertise because of the movement of hospital-based to community- based care. Caring for people at home is no longer solely concerned with prevention, but delivering complex care to patients who are acutely unwell or at the end of their life. Little is known about the distinct expertise of community nurses, or their contribution to patient outcomes. There is a need to examine expertise in this group in order to inform current and future care provision within community settings. Design A hermeneutic, phenomenological study. Method Semi-structured interviews were conducted with eight community nurses in Scotland, UK, who hold an additional post-registration, professional qualification. Participants also kept audio-journals. Data were analysed using Interpretive Phenomenological Analysis. Findings Participants described their expertise in three themes; negotiating a 'way in' to care, managing complexity, and 'thinking on your feet'. They did not refer to themselves as specialist practitioners, nor did they perceive that they were viewed as specialist by colleagues or management. They appeared to dismiss their range of expertise which included forming trusting relationships, anticipating care needs and problem-solving, enabling them to undertake complex care management. Conclusions Expertise of community nurses in this study is dynamic, contextualised and action-oriented enabling them to be creative problem-solvers. It reflects engagement with patients and families and all aspects of the setting where care is provided, rather than being solely an identifiable set of specialist skills, Relevance to clinical practice It is vital to recognize community-based expertise internationally, especially if current WHO aims for community-based health care are to be achieved. Highlighting this expertise contributes to current discourse and may be considered in education and practice reviews. This article is protected by copyright. All rights reserved.sch_nur27pub4806pub3-