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Seattle, WA, United States

McFarlane G.J.,Health 123
Perspectives in Public Health | Year: 2010

If asked to describe the key public health challenges of our time many practitioners might well cite issues such as health inequalities, obesity, smoking and poverty. However, with the greatest of respect to those agendas, they are not, in my view, the greatest priority at present. If we cannot learn to live within sustainable limits and damage beyond repair the essential life support systems that we depend on, they will fail catastrophically with horrific consequences for humanity. All credible, reliable scientific evidence suggests that without profound and significant change that is exactly where we are headed. However, there is time, albeit short, to avoid the very worst consequences of runaway climate change. But to do so requires collective and urgent action now! Public health practitioners have potentially so much to offer towards this effort. We have many of the skills and experience so critically needed to advocate for change - both political and behavioural; we have the ability to design creative, effective, and dynamic interventions to assist and facilitate communities and individuals make the journey; and equally importantly we have huge opportunities to do so. However to do so effectively means that we need to look at the problem through a different lens and make climate change a top public health priority. We need to see beyond many of the institutional and cultural barriers that exist, albeit not through deliberate design, within our organisations which can cause us to be focused on very specific agendas and see the whole wood, rather than individual trees within it. Climate change is not just an "environmental" problem and a priority therefore specifically for that sector. It is already costing lives and is life threatening on a scale that far surpasses current public health concerns and priorities. Equally critically, tackling climate change would and will significantly contribute towards addressing health inequalities. To use two well worn public health cliché's, climate change is everyone's business. And it must be a case of prevention because there will be, in this instance, no cure! © 2010 Royal Society for Public Health. Source


Recently, several reports have described a waning response of Mycobacterium tuberculosis (TB)-specific interferon-gamma (IFN-gamma) release assays (IGRAs) performed years after the initial TB infection. Since a considerable part of elderly people in Japan was infected with TB in their youth, it was hypothesized that if the general population was screened with IGRAs, the mean IFN-gamma value of positive subjects (POSITIVES) would be reduced as the age of the subjects increased. Conversely, in subjects who were recently exposed to TB (CONTACTS), it was assumed that the POSITIVES would include subjects with new TB infections who show a high IFN-gamma value and those with old TB infections who show a low IFN-gamma value. Since the presence of subjects with old infections among the POSITIVES cannot be avoided during examinations, it is hypothesized that the mean IFN-gamma value of the POSITIVES decreases as the age of the CONTACTS increases. To test this hypothesis for CONTACTS, data acquired during the contact examinations at Adachi Public Health Center in Tokyo, Japan were analyzed. Since it is thought that the grade of exposure of the TB index case (INDEX CASE) influences the IFN-gamma value, its relationship with the INDEX CASE and the infectivity of the INDEX CASE were also investigated. In the CONTACTS, as only a few healthcare workers are < 20 years old or > 70 years old, the subjects were chosen from individuals aged in the range of 20-69 years who had been in contact with a TB patient within the past 3 months. The IFN-gamma value of the 188 POSITIVES in the 1145 CONTACTS who underwent a contact examination using the IGRA QuantiFERON-TB Gold In-Tube (QFT-G-IT) assay was investigated. The POSITIVES were divided according to their age class, and their IFN-gamma values were compared. In addition, after dividing all POSITIVES into groups to assess their relationship with the INDEX CASE (i.e., household, relative, healthcare worker, and others), the IFN-gamma values of the 20-49- and 50-69-year-old classes were compared in each group. There was no significant difference in the IFN-gamma values between the age classes, (Kruskal-Wallis test, P = 0.598). When the IFN-gamma values of the POSITIVES in the 20-49- and 50-69-year-old classes were compared for each relationship group, the mean IFN-gamma value of the POSITIVES increased in proportion to the rise in age only in the healthcare worker group. This occurred even though the mean IFN-gamma value of the POSITIVES decreased in many groups as their age increased. A significant difference was confirmed in the IFN-gamma values between the age classes in the healthcare worker group (Wilcoxon rank-sum test, P < 0.001). No significant difference was observed in the infectivity of the INDEX CASE between the age classes in the healthcare worker group. Initially, it seemed that the high infectivity of the INDEX CASE affected the IFN-gamma values of the POSITIVES in the oldest age class; in other words, the factor expected to decrease actually increased. However, comparison of the IFN-gamma value by age class in each relationship group revealed that, in the healthcare worker group only, the IFN-gamma value of POSITIVES increased in proportion to the rise in age regardless of infectivity of the INDEX CASE. Since it has been hypothesized that healthcare workers have an increased chance of contact with TB patients than other relationships, this outcome suggests the existence of a booster effect on people who are repeatedly exposed to TB, as assessed using IGRAs, as one of the several possibilities. If this booster effect seen with IGRAs is proven, predicting the development of symptoms and presuming the infection time by using IFN-gamma values will be difficult. To validate the present results, animal experiments that can be adjusted for various biases and confounding factors are necessary. Source


Ramseier L.E.,University of Zurich | Janicki J.A.,Childrens Memorial Hospital | Weir S.,Health 123 | Narayanan U.G.,University of Toronto
Journal of Bone and Joint Surgery - Series A | Year: 2010

Background: The optimal management of femoral fractures in adolescents is controversial. This study was performed to compare the results and complications of four methods of fixation and to determine the factors related to those complications. Methods: We conducted a retrospective cohort study of 194 diaphyseal femoral fractures in 189 children and adolescents treated with elastic stable intramedullary nail fixation, external fixation, rigid intramedullary nail fixation, or plate fixation. After adjustment for age, weight, energy of the injury, polytrauma, fracture level and pattern, and extent of comminution, treatment outcomes were compared in terms of the length of the hospital stay, time to union, and complication rates, including loss of reduction requiring a reoperation, malunion, nonunion, refracture, infection, and the need for a reoperation other than routine hardware removal. Results: The mean age of the patients was 13.2 years, and their mean weight was 49.5 kg. There was a loss of reduction of two of 105 fractures treated with elastic nail fixation and ten of thirty-three treated with external fixation (p < 0.001). At the time of final follow-up, five patients (two treated with external fixation and one in each of the other groups) had ≥2.0 cm of shortening. Eight of the 104 patients (105 fractures) treated with elastic nail fixation underwent a reoperation (two each because of loss of reduction, refracture, the need for trimming or advancement of the nail, and delayed union or nonunion). Sixteen patients treated with external fixation required a reoperation (ten because of loss of reduction, one for replacement of a pin complicated by infection, one for débridement of the site of a deep infection, three because of refracture, and one for lengthening). One patient treated with a rigid intramedullary nail required débridement at the site of a deep infection, and one underwent removal of a prominent distal interlocking screw. One fracture treated with plate fixation required refixation following refractures. A multivariate analysis with adjustment for baseline differences showed external fixation to be associated with a 12.41-times (95% confidence interval = 2.26 to 68.31) greater risk of loss of reduction and/or malunion than elastic stable intramedullary nail fixation. Conclusions: External fixation was associated with the highest rate of complications in our series of adolescents treated for a femoral fracture. Although the other three methods yielded comparable outcomes, we cannot currently recommend one method of fixation for all adolescents with a femoral fracture. The choice of fixation will remain influenced by surgeon preference based on expertise and experience, patient and fracture characteristics, and patient and family preferences. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated. Source


Our objective was to evaluate a pharmacist-delivered comprehensive medication management (CMM) service provided to patients with psychiatric disorders. We conducted a retrospective review and analysis of medication-related data, and a return on investment cost analysis. The project consisted of 154 patients with psychiatric disorders who were referred to the CMM service by physicians, therapists, case managers, friends, or family, and were seen by the service between April 2011 and July 2013. CMM evaluates a patient's medications to ensure that they are appropriate, effective, safe, and convenient. Patients were seen by pharmacists trained in CMM and the treatment of mental illnesses, including one board-certified psychiatric pharmacist. All medications were reviewed including prescriptions, over-the-counter medications, and nutritional supplements. The patients' medication-related concerns, goals of treatment, vital signs, and laboratory studies were reviewed. Drug therapy problems such as adverse reactions, unnecessary medications, excessive doses, and poor medication adherence were identified, and written recommendations were mailed to patients and physicians within 1 week. Patients were offered follow-up in 4-6 weeks and were seen as many times as needed to resolve drug therapy problems. The 154 patients completed 256 CMM visits. A mean of 10.1 medical and psychiatric conditions and 13.7 medications/person were assessed. A mean of 5.6 drug therapy problems/patient were identified. A total net cost savings was estimated to be $90,484.00, with a mean savings of $586.55/patient. The cost of providing the service was estimated at $32,185.93. The return on investment was estimated to be 2.8; thus for every dollar spent on providing the service, $2.80 was estimated to be saved. Patients with mental illnesses may benefit from pharmacist-delivered CMM to help resolve drug therapy problems. Medication management may improve clinical outcomes and reduce costs. In addition, patients valued the opportunity to review their medications with a pharmacist. © 2014 Pharmacotherapy Publications, Inc. Source


Wellock V.K.,Health 123
Midwifery | Year: 2010

Background: domestic abuse affects one in three women in the UK and can have long-term consequences for those concerned and their families. Guidelines suggest that all women should be asked about domestic abuse, and the Department of Health has suggested ways of supporting this issue. Health-care professionals could find themselves with a woman who cannot speak English, and may require the support of an interpreter. Current guidelines are not suitable for Black and minority-ethnic women, and midwives may not have enough cultural awareness to support these women. Aim: to interview bilingual women in the community to explore: (1) how domestic abuse is viewed in their culture; and (2) who should be questioning women about this sensitive issue. Method: a qualitative phenomenological study using semi-structured interviews with non-pregnant bilingual workers within the local community. Findings: women's lives were influenced by their in-laws and family, status, attitudes to marriage arrangements and gossiping in the community. All of these factors affected disclosure. Conclusions: health-care professionals must understand that women take serious measures to hide the fact that they are victims of abuse in order to preserve family honour. Divulging information to interpreters or relatives is a problem because of lack of confidentiality and gossiping in the community. © 2008 Elsevier Ltd. All rights reserved. Source

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