Value of prominent flow voids without cord edema in the detection of spinal arteriovenous fistulae

Purpose: To determine the prevalence of spinal dural arteriovenous fistulae (SDAVF) in patients presenting with prominent vascular flow voids on imaging without other imaging findings suggestive of SDAVF. Methods: We retrospectively identified patients from January 1, 2005 to March 1, 2012 who underwent spinal angiography for suspected SDAVF with prominent vascular flow voids on prior imaging. We excluded patients with other major spinal pathology or other imaging findings of SDAVF including cord hyperintensity, enhancement, or expansion. We calculated the proportion of patients with positive findings for SDAVF on angiography and evaluated the prevalence of SDAVF for this finding alone and in correlation with clinical findings. Results: 18 patients underwent spinal angiography for prominent flow voids on imaging without other spinal pathology or imaging findings of SDAVF. Three had a SDAVF detected on angiography. The prevalence of SDAVF in this population was low, only 17% (95% CI 6-39%). All of the patients with positive angiography findings had myelopathy, increasing the prevalence to 100% if the additional clinical finding of myelopathy was present. Conclusions: Prominent flow voids without other imaging findings suggestive of SDAVF is poorly predictive of the presence of a SDAVF, unless myelopathy is present clinically. © 2014 Alhilali et al

Disability, Home Physical Environment and Non-Fatal Injuries among Young Children in China

We compared the patterns of medically attended injuries between children with and without disabilities and explored the residential environment risks in five counties of Hubei Province in the People's Republic of China by a 1:1 matched case-control study based on the biopsychosocial model of the International Classification of Functioning, Disability and Health--ICF.1201 children aged 1-14 with disabilities and 1201 their healthy counterparts matched as having the same gender, same age, and lived in the same neighborhood were recruited in our study. Characteristics of injuries in the past 12 months were compared between children with and without disabilities. The associations among disability status, home environment factors and injuries were examined in logistic regression analysis taking into account sociodemographic factors.Children with disabilities had a significantly higher prevalence of injury than children without disabilities (10.2% vs. 4.4%; P<.001). The two groups differed significantly in terms of number of injury episodes, injury place and activity at time of injury. Falls were the leading mechanism of injury regardless of disability status. Most of the injury events happened inside the home and leisure activities were the most reported activity when injured for both groups. The univariate OR for injury was 4.46 (2.57-7.74) for the disabled children compared with the non-disabled children. Disabled children whose family raised cat/dog(s) were 76% more likely to be injured during the last 12 months (OR = 1.76; 95% CI = 1.02, 3.02), comparing with those whose family did not have any cat/dog. And for children without disabilities, those whose family had cat/dog(s) were over 3 times more likely to having injuries comparing with those whose family did not have any cat/dog.Children with disabilities had a significantly increased risk for injury. Interventions to prevent residential injury are an important public health priority in children with disabilities

The Recognition of and Care Seeking Behaviour for Childhood Illness in Developing Countries: A Systematic Review

Background: Pneumonia, diarrhoea, and malaria are among the leading causes of death in children. These deaths are largely preventable if appropriate care is sought early. This review aimed to determine the percentage of caregivers in low- and middle-income countries (LMICs) with a child less than 5 years who were able to recognise illness in their child and subsequently sought care from different types of healthcare providers. Methods and Findings: We conducted a systematic literature review of studies that reported recognition of, and/or care seeking for episodes of diarrhoea, pneumonia or malaria in LMICs. The review is registered with PROSPERO (registration number: CRD42011001654). Ninety-one studies met the inclusion criteria. Eighteen studies reported data on caregiver recognition of disease and seventy-seven studies on care seeking. The median sensitivity of recognition of diarrhoea, malaria and pneumonia was low (36.0%, 37.4%, and 45.8%, respectively). A median of 73.0% of caregivers sought care outside the home. Care seeking from community health workers (median: 5.4% for diarrhoea, 4.2% for pneumonia, and 1.3% for malaria) and the use of oral rehydration therapy (median: 34%) was low. Conclusions: Given the importance of this topic to child survival programmes there are few published studies. Recognition of diarrhoea, malaria and pneumonia by caregivers is generally poor and represents a key factor to address in attempts to improve health care utilisation. In addition, considering that oral rehydration therapy has been widely recommended for over forty years, its use remains disappointingly low. Similarly, the reported levels of care seeking from community health workers in the included studies are low even though global action plans to address these illnesses promote community case management. Giving greater priority to research on care seeking could provide crucial evidence to inform child mortality programmes

Who needs 'pukka anthropologists'? A study of the perceptions of the use of anthropology in tropical public health research.

Over the past 50 years, there have been considerable changes both in how medical anthropologists view their relationship to tropical public health and in how tropical public health professionals view the role of anthropologists. In particular, in recent decades critical currents have emerged from an anthropology of medicine, calling for an examination of biomedicine and its conceptualisation of public health. There are parallel debates in public health about a narrow disease-focused or broader socio-cultural approach to improving population health. Based on a review of the literature and a qualitative study of the views of public health professionals and anthropologists working in tropical public health, the data presented in this paper suggest that public health professionals remain unaware of many of the contributions anthropology could make to tropical public health theory and practice. However, the objectives of a critical social science are not dissimilar to those of the broader concept of public health. We suggest that there are grounds for optimism. For those of us concerned not just with disease but also with inequities in health, the challenge is to work towards a critical tropical public health which draws as much from social science as from biomedicine, in theory and practice

Tecnologias de enfermagem para promoção do aleitamento materno: revisão integrativa da literatura Tecnologías de enfermería para promover la lactancia materna: revisión integradora Nursing technologies to promote breastfeeding: integrative literature review

Objetivou-se realizar uma revisão integrativa da literatura sobre os tipos de tecnologias que o enfermeiro tem desenvolvido ou que o mesmo poderia utilizar para a promoção do aleitamento materno. Realizou-se em outubro de 2009 uma busca com os descritores aleitamento materno (breastfeeding), enfermagem (nursing) e tecnologia (technology) nas bases: CINAHL, Scopus, PubMed e LILACS. Encontraram-se 127 referências, das quais dez participaram da análise por atenderem aos critérios de seleção do estudo. Verificou-se que a maioria dos estudos (6 - 60%) foi encontrada no Pubmed, na língua inglesa (8 - 80%) e não citou o tipo de estudo (4 - 40%). Identificaram-se 13 tipos de tecnologias para o cuidado, classificadas como dura (8 - 61,5%) e leve (5 - 38,5%), cujo principal público-alvo foi mães de crianças (9 - 90%), sendo a tecnologia mais utilizada o vídeo/filmagem (4 - 40%). Assim, deve-se estimular o uso de tecnologias, sobretudo as consideradas leves e leves-duras, por serem práticas, facilmente desenvolvidas e aplicáveis.<br>El objetivo fue hacer una revisión integradora sobre los tipos de tecnologías que el enfermero ha desarrollado o que lo mismo podrá utilizarse para la promoción de la lactancia materna. Llevado a cabo en octubre de 2009 por meio de una búsqueda con los descriptores: lactancia materna (breastfeeding), enfermería (nursing) y tecnología (technology) en las bases: CINAHL, Scopus, PubMed y LILACS. Se han encontrado 127 referencias, de las cuales diez participaron del análisis por cumpriren los criterios de selección del estudio. Se encontró que la mayoría (60 - 60%) de los estudios fue encontrada en PubMed, en inglés (80 - 80%) y no se mencionó el tipo de estudio (4 - 40%). Se identificaron trece tipos de tecnologías para el cuidado, clasificadas como dura (8 a 61,5%) y leve (5 a 38,5%), cuyo principal público fue las madres de los niños (90-90%), y la tecnología más utilizada fue de vídeo / cine (4 - 40%). Por lo tanto, se debe fomentar el uso de tecnologías, sobretodo las consideradas leves y leves-dura, porque son prácticas, fácilmente desarrolladas y aplicables.<br>This paper aims to accomplish an integrative literature review on the types of technologies that nurses have developed or that they could use to promote breastfeeding. A research was carried out in October 2009 using the descriptors: breastfeeding, nursing and technology, in the CINAHL, Scopus, PubMed and LILACS databases. 127 references were found, 10 of them participated in the analysis for they fit the study selection criteria. It was verified that most (6 - 60%) of the studies were found in Pubmed, in English (8 - 80%) and didn't mention the study type (4 - 40%). Thirteen types of care technologies were identified, classified as hard (8 - 61.5%) and soft (5 - 38.5%), the main target audience was formed by children's mothers (9 - 90%), with the video/footage as the most used technology (4 - 40%). The use of soft and soft-hard technologies should be stimulated, for they are considered practical, easily developable and appliable

Asian Americans’ Reports of Their Health Care Experiences: Results of a National Survey

OBJECTIVE: To examine how Asian race/ethnicity affects patients’ health care experiences and satisfaction with care. DESIGN: Telephone interview using random-digit dialing, stratified to over-sample adults living in areas with disproportionately large numbers of minorities. PARTICIPANTS AND SETTING: White (N = 3,205) and Asian-American (N = 521) respondents, weighted to represent all such adults living in the continental U.S. in telephone households. MEASUREMENTS: Reports of health care experiences and trust in the doctor at the last visit, and overall satisfaction with care and desire to change doctors in the last 2 years. MAIN RESULTS: Asian Americans were less likely than whites to report that their doctors ever talked to them about lifestyle or mental health issues (P ≤ .01). They were more likely to report that their regular doctors did not understand their background and values (P ≤ .01). When asked about the last visit, they were more likely to report that their doctors did not listen, spend as much time, or involve them in decisions about care as much as they wanted (all P ≤ .0001). In multivariable analyses, Asian Americans were less likely than whites to report that they were very satisfied with care (odds ratio [OR], 0.64, 95% confidence interval [CI], 0.42 to 0.99). However, they were not significantly less likely than whites to trust their doctors (OR, 0.79, 95% CI, 0.52 to 1.20), or to change doctors (OR, 0.93, 95% CI, 0.56 to 1.56). CONCLUSIONS: In a national survey, Asian Americans were less likely to receive counseling and less likely to report positive interactions with their doctors than white respondents. More research is needed to determine the reasons for these differences