Antibiotics to improve recovery following tonsillectomy: a systematic review.

OBJECTIVE: To determine if antibiotics improve recovery following tonsillectomy. STUDY DESIGN: DATA SOURCES: Electronic databases Medline, Embase, and Cochrane Controlled Trials Register were searched using relevant search terms. Additional trials, if any, were retrieved by searching the references from all identified trials, reviews, correspondences, editorials, and conference proceedings. No language restriction was applied. STUDY SELECTION: Systematic review of trials in which antibiotic was administered as a study medication intraoperatively and/or postoperatively, in children or adults undergoing tonsillectomy or adenotonsillectomy. Only randomized, placebo-controlled, double-blind trials attaining preset quality scores were included. Outcomes analyzed: 1) pain, need for analgesia, fever, halitosis, and return to normal diet and activities; 2) secondary hemorrhage using 2 parameters-significant hemorrhage (ie, warranting readmission, blood transfusion, or return to theatre for hemostasis) and total hemorrhage; and 3) adverse events. RESULTS: Five trials met the eligibility criteria. Antibiotics significantly reduced the number of subjects manifesting fever (relative risk [RR]: 0.62, 95% confidence interval [CI]: 0.45, 0.85) and duration of halitosis (-1.94 [-3.57, -0.30] days), and marginally reduced the time taken to resume normal activity (-0.63 [-1.12, -0.14] days), but had no significant effect in reducing pain scores (-0.01 [-0.60, 0.57]) or need for analgesia. Similarly, there was no significant difference in the time taken to resume normal diet or incidence of significant and total hemorrhage, although data was underpowered to detect differences for these outcomes. In the antibiotic group 4 patients developed an adverse reaction (3 cases of rash and 1 case of oropharyngeal candidiasis), while in the control group 1 patient had an adverse reaction (rash). The RR of antibiotic-related adverse events was 2.45 (0.45, 13.31). CONCLUSION: Antibiotics appear to be effective in reducing some, but not all, morbid outcomes following tonsillectomy, and may increase the risk of adverse events. Further trials are needed to better define the role of antibiotics in facilitating post-tonsillectomy recovery. EBM RATING: A-1a

Remote working: survey of attitudes to eHealth of doctors and nurses in rural general practices in the United Kingdom.

BACKGROUND: Health professionals in rural primary care could gain more from eHealth initiatives than their urban counterparts, yet little is known about eHealth in geographically isolated areas of the UK. OBJECTIVE: To elicit current use of, and attitudes towards eHealth of professionals in primary care in remote areas of Scotland. METHODS: In 2002, a questionnaire was sent to all general practitioners (n=154) in Scotland's 82 inducement practices, and to 67 nurses. Outcome measures included reported experience of computer use; access to, and experience of eHealth and quality of that experience; views of the potential usefulness of eHealth and perceived barriers to the uptake of eHealth. RESULTS: Response rate was 87%. Ninety-five percent of respondents had used either the Internet or email. The proportions of respondents who reported access to ISDN line, scanner, digital camera, and videoconferencing unit were 71%, 48%, 40% and 36%, respectively. Use of eHealth was lower among nurses than GPs. Aspects of experience that were rated positively were 'clinical usefulness', 'functioning of equipment' and 'ease of use of equipment' (76%, 74%, and 74%, respectively). The most important barriers were 'lack of suitable training' (55%), 'high cost of buying telemedicine equipment' (54%), and 'increase in GP/nurse workload' (43%). Professionals were concerned about the impact of tele-consulting on patient privacy and on the consultation itself. CONCLUSIONS: Although primary healthcare professionals recognize the general benefits of eHealth, uptake is low. By acknowledging barriers to the uptake of eHealth in geographically isolated settings, broader policies on its implementation in primary care may be informed

Multilevel Analysis of Trachomatous Trichiasis and Corneal Opacity in Nigeria : The Role of Environmental and Climatic Risk Factors on the Distribution of Disease.

Funding: Jennifer L Smith was supported by the International Trachoma Initiative through a grant from the Bill and Melinda Gates Foundation. Anthony Solomon is a Wellcome Trust Intermediate Clinical Fellow (098521). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Coverage of hospital-based cataract surgery and barriers to the uptake of surgery among cataract blind persons in nigeria: the Nigeria National Blindness and Visual Impairment Survey.

PURPOSE: To determine cataract surgical coverage, and barriers to modern cataract surgery in Nigeria. METHODS: Multistage stratified cluster random sampling was used to identify a nationally representative sample of 15,027 persons aged 40+ years. All underwent visual acuity testing, frequency doubling technology visual field testing, autorefraction, and measurement of best corrected vision if <6/12 in one or both eyes. An ophthalmologist examined the anterior segment and fundus through an undilated pupil for all participants. Participants were examined by a second ophthalmologist using a slit lamp and dilated fundus examination using a 90 diopter condensing lens if vision was <6/12 in one or both eyes, there were optic disc changes suggestive of glaucoma, and 1 in 7 participants regardless of findings. All those who had undergone cataract surgery were asked where and when this had taken place. Individuals who were severely visually impaired or blind from unoperated cataract were asked to explain why they had not undergone surgery. RESULTS: A total of 13,591 participants were examined (response rate 89.9%). Prevalence of cataract surgery was 1.6% (95% confidence interval 1.4-1.8), significantly higher among those aged ≥70 years. Cataract surgical coverage (persons) in Nigeria was 38.3%. Coverage was 1.7 times higher among males than females. Coverage was only 9.1% among women in the South-South geopolitical zone. Over one third of those who were cataract blind said they could not afford surgery (36%). CONCLUSIONS: Cataract surgical coverage in Nigeria was among the lowest in the world. Urgent initiatives are necessary to improve surgical output and access to surgery

Lifetime cancer risk and combined oral contraceptives : the Royal College of General Practitioners’ Oral Contraception Study

Funding: The study has received funding from the Royal College of General Practitioners, Medical Research Council, Imperial Cancer Research Fund, British Heart Foundation, Schering AG, Schering Health Care Ltd, Wyeth Ayerst International, Ortho Cilag and, Searle. None of these funders have contributed to the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review or approval of the manuscript.Peer reviewedPostprin

Prevalence and risk factors for hypertension and association with ethnicity in Nigeria: results from a national survey.

OBJECTIVE: Non-communicable diseases are now a global priority. We report on the prevalence of hypertension and its risk factors, including ethnicity, in a nationally representative sample of Nigerian adults recruited to a survey of visual impairment. METHODS: multi-stage, stratified, cluster random sample with probability proportional to size procedures was used to obtain a nationally representative sample of 13 591 subjects aged ≥ 40 years. Of these, 13 504 (99.4%) had a blood pressure measurement. RESULTS: The prevalence of hypertension was 44.9% [95% confidence interval (CI): 43.5-46.3% ]. Increasing age, gender, urban residence and body mass index were independent risk factors (p < 0.001). The Kanuri ethnic group had the highest prevalence of hypertension (77.5%, 95% CI: 71.0-84.0%). CONCLUSIONS: The high prevalence of hypertension in Nigeria is a cause for concern and suggests that it is inevitable that the impact of hypertension-related ill health is imminent, with the accompanying financial and societal costs to families and the state of Nigeria

Prevalence, causes, and risk factors for functional low vision in Nigeria: results from the national survey of blindness and visual impairment.

PURPOSE: To estimate prevalence and describe causes of functional low vision (FLV) among a nationally representative sample of Nigerian adults, assess socioeconomic risk factors, and estimate the number of adults in Nigeria who might benefit from low vision assessment or rehabilitation services. METHODS: Multistage, stratified, cluster random sampling with probability proportional to size procedures were used to identify a nationally representative sample of 15,027 persons aged 40 years or older. Distance vision was measured using a reduced logMAR tumbling E-chart. All participants with presenting acuity of <6/12 in one or both eyes had their corrected acuity measured and underwent detailed clinical examination to determine the cause. FLV was defined as best corrected vision <6/18 in the better eye, after excluding those with no light perception in both eyes and those with treatable causes. Analysis took account of the clustered design. RESULTS: In all, 13,591 individuals were examined in 305 clusters (response rate, 89.9%). The crude prevalence of FLV was 3.5% (95% confidence interval, 3.1-3.9%). This was lower than the prevalence of blindness, which was 4.2%. Glaucoma was the most common cause and age the most important risk factor. There are estimated to be approximately 5000 adults with FLV per million population and 340 who are totally blind. Only 9.3% of those with FLV were of working age and literate. CONCLUSIONS: These are the first data on the prevalence, causes, and risk factors for FLV from Africa. Results support studies from Asia that the prevalence of FLV is lower than previously thought. Because the majority of adults with FLV in Nigeria live in rural areas and are elderly and not literate, further research is required to assess the nature of the interventions required and who might best deliver them

Prevalence and risk factors for lens opacities in Nigeria: results of the national blindness and low vision survey.

PURPOSE: Investigate prevalence and risk factors for lens opacities among a nationally representative sample of Nigerians aged ≥ 40 years. METHODS: Across 305 clusters, 13,591 adults were examined. Every seventh participant (n = 1722) was sampled systematically and examined in detail, including lens opacity grading. Lenses were examined at the slit-lamp with pupil dilation and graded using the World Health Organization (WHO) system. Significant opacities were defined as nuclear, cortical, or posterior subcapsular opacity of WHO grade >1, or hyper/mature cataract. The category "Any Opacity" included hyper/mature opacity and aphakia/pseudophakia/couching. Data were collected on sociodemographic and environmental factors, including height and weight. RESULTS: A total of 1631/1722 (95%) in the normative subsample had their lenses graded. Prevalence of "Any Opacity" was 19.8% (95% confidence interval [CI]: 7.9-21.7) the prevalence of all types increased with age, and was higher in females and those not literate. Prevalence of nuclear, cortical, and posterior subcapsular were 8.8% (95% CI: 7.5-10.1); 11.7% (95% CI: 10.0-13.3); and 2.9% (95% CI: 2.1-3.8), respectively. In multivariate analysis, age was an independent risk factor for all types. Nuclear opacity was also associated with female sex (odds ratio [OR] 2.4; 95% CI: 1.5-3.6); lean body mass index (BMI; OR 2.0; 95% CI: 1.1-3.5); and the Igbo ethnic group (OR 4.4; 95% CI: 2.3-8.4). Cortical opacity was also associated with female sex (OR 2.1; 95% CI: 1.5-3.0) and the Yoruba (OR 0.45; 95% CI: 0.3-0.8), but not with BMI. "Other Lens Opacities," which includes couching, was significantly lower in the Guinea savannah region (OR 0.4; 95% CI: 0.2-0.9), while living in rain forest areas was protective for posterior subcapsular cataracts (OR 0.3; 95% CI: 0.1-0.7). CONCLUSIONS: A fifth of Nigerian adults have some degree of lens opacity. Further studies are needed to investigate the role of ethnicity, climate variables, and other risk factors

Clinical peripherality: development of a peripherality index for rural health services

BACKGROUND: The configuration of rural health services is influenced by geography. Rural health practitioners provide a broader range of services to smaller populations scattered over wider areas or more difficult terrain than their urban counterparts. This has implications for training and quality assurance of outcomes. This exploratory study describes the development of a "clinical peripherality" indicator that has potential application to remote and rural general practice communities for planning and research purposes. METHODS: Profiles of general practice communities in Scotland were created from a variety of public data sources. Four candidate variables were chosen that described demographic and geographic characteristics of each practice: population density, number of patients on the practice list, travel time to nearest specialist led hospital and travel time to Health Board administrative headquarters. A clinical peripherality index, based on these variables, was derived using factor analysis. Relationships between the clinical peripherality index and services offered by the practices and the staff profile of the practices were explored in a series of univariate analyses. RESULTS: Factor analysis on the four candidate variables yielded a robust one-factor solution explaining 75% variance with factor loadings ranging from 0.83 to 0.89. Rural and remote areas had higher median values and a greater scatter of clinical peripherality indices among their practices than an urban comparison area. The range of services offered and the profile of staffing of practices was associated with the peripherality index. CONCLUSION: Clinical peripherality is determined by the nature of the practice and its location relative to secondary care and administrative and educational facilities. It has features of both gravity model-based and travel time/accessibility indicators and has the potential to be applied to training of staff for rural and remote locations and to other aspects of health policy and planning. It may assist planners in conceptualising the effects on general practices of centralising specialist clinical services or administrative and educational facilities

Changes in Scottish suicide rates during the Second World War

BACKGROUND: It is believed that total reported suicide rates tend to decrease during wartime. However, analysis of suicide rates during recent conflicts suggests a more complex picture, with increases in some age groups and changes in method choice. As few age and gender specific analyses of more distant conflicts have been conducted, it is not clear if these findings reflect a change in the epidemiology of suicide in wartime. Therefore, we examined suicide rates in Scotland before, during and after the Second World War to see if similar features were present. METHODS: Data on deaths in Scotland recorded as suicide during the period 1931 – 1952, and population estimates for each of these years, were obtained from the General Register Office for Scotland. Using computer spreadsheets, suicide rates by gender, age and method were calculated. Forward stepwise logistic regression was used to assess the effect of gender, war and year on suicide rates using SAS V8.2. RESULTS: The all-age suicide rate among both men and women declined during the period studied. However, when this long-term decline is taken into account, the likelihood of suicide during the Second World War was higher than during both the pre-War and post-War periods. Suicide rates among men aged 15–24 years rose during the Second World War, peaking at 148 per million (41 deaths) during 1942 before declining to 39 per million (10 deaths) by 1945, while the rate among men aged 25–34 years reached 199 per million (43 deaths) during 1943 before falling to 66 per million (23 deaths) by 1946. This was accompanied by an increase in male suicides attributable to firearms and explosives during the War years which decreased following its conclusion. CONCLUSION: All age male and female suicide rates decreased in Scotland during World War II. However, once the general background decrease in suicide rates over the whole period is accounted for, the likelihood of suicide among the entire Scottish population during the Second World War was elevated. The overall decrease in suicide rates concealed large increases in younger male age groups during the War years, and an increase in male suicides recorded as due to the use of firearms. We conclude that the effects of war on younger people, reported in recent conflicts in Central Europe, were also seen in Scotland during the Second World War. The results support the findings of studies of recent conflicts which have found a heterogeneous picture with respect to age specific suicide rates during wartime