The Architecture of a Software System for Supporting Community-based Primary Health Care with Mobile Technology: The Mobile Technology for Community Health (MoTeCH) Initiative in Ghana

This paper describes the software architecture of a system designed in response to the health development potential of two concomitant trends in poor countries: i) The rapid expansion of community health worker deployment, now estimated to involve over a million workers in Africa and Asia, and ii) the global proliferation of mobile technology coverage and use. Known as the Mobile Technology for Community Health (MoTeCH) Initiative, our system adapts and integrates existing software applications for mobile data collection, electronic medical records, and interactive voice response to bridge health information gaps in rural Africa. MoTeCH calculates the upcoming schedule of care for each client and, when care is due, notifies the client and community health workers responsible for that client. MoTeCH also automates the aggregation of health status and health service delivery information for routine reports. The paper concludes with a summary of lessons learned and future system development needs.     

Low polar volatile constituents from Isodon excisa by GC-MS

An attempt had been made to isolate and identify the low polar volatile constituents from Isodon excisa. The dried plants were heat extracted with ethanol and then extracted with petroleum ether. The constituents were isolated and analyzed by GC-MS and then we retrieved them on NIST08 mass spectrometry database to determine their structures. Finally, successful results were achieved, 111 compounds were obtained and identified. 105 of them were reported for the first time in Isodon excisa and 22 of them were first found in natural products. Thus, the main constituents of it were found to be Sitosterol (33.28%), 3-Amino-4-pyrazolecarbonitrile (9.55%).     

Caucasian and Mexican American low‐income children's thoughts about vegetables and fruits

The objective of this study was to determine behavioral, personal, and environmental factors that influence low‐income children's fruit and vegetable intake. Focus group questions were developed using the social cognitive theory (SCT). Four Caucasian (27 children) and six Mexican American focus groups (30 children) were conducted. Mexican‐American children stated they had the ability to prepare vegetables and fruits whereas Caucasian children expressed they would rather have their parents do the preparation. This is an example of the behavioral capability construct of SCT. Both ethnic groups mentioned they did not know where vegetables and fruits were stored in the home and this is an environmental construct of SCT. Personal factors of the SCT included Caucasian children preferring to add peanut butter and Ranch dip to vegetables compared to Mexican‐American children preferring to add salt, lime, and chili to vegetables. Sweetness, sourness, juiciness, and crunchiness were seen as good characteristics. All focus groups perceived vegetables and fruits as healthy. All of these issues need to be considered when developing nutrition programming for children.     

Treatment and Outcomes in Occupational Low Back Pain

ABSTRACT

Low back pain (LBP) is the sin gle larg est musculoskeletal injury inthe working pop u la tion, and the sec ond most com mon reason for vis its to pri mary care physicians. D e spite its frequency, thepathologic diagnosis is un certain in 85% of cases. Out comes, particularly in work related LBP vary widely as does treat ment. Numerous guidelines have been re cently promulgated to speed treatment, improve out comes and minimize cost.

This study follows 709 workers with low back pain.

Methods: Seven hun dred and nine se rial low back pain pa tients werefol lowed through two years. Their charts were au dited for diag nos tics, ther a peutics, refer rals and out comes. The dif fer ingfacets of clinical treatment paradigms are compared with out comes.

Results: Out of five cat e go ries, al most half of back in juries re sulted from heavy lift ing alone. Out of 709 pa tients, 1.4% eventu ally re quired sur gery. Only 10 pa tients were clin i cally dis abled at the end of the study pe riod al though a total of 30 did not re turnto work for a va ri ety of reasons. Al most 39% of pa tients re ceived back X-rays, and 10% re ceived MRIs of the lower back. Ninety-three per cent re ceived NSAIDs as part of their treat ment, and 34% nar cot ics. Nei ther NSAIDs nor mus cle re lax-ants cor re lated with prob a bil ity of re turnto work. The me diantreat ment inter val wasseven days, with the ma jor ity of pa tients (551/709) re turned to reg u lar work withintwo weeks of thefirst of ficevisit. Pro longed duration of treat ment and sur gery cor re lated with lit i ga tion.

Con clu sions: De spite popular clinical mythology, thevast majority of occupationally acquired low back pain pa tients do re turnto work in a timely fash ion.     

Professional Association Response to the Manga Report

Abstract

The report entitled “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain” was funded by the Ontario Ministry of Health and undertaken by Pran Manga and Associates. Known as the Manga report, for its lead author, economist Pran Manga, the report raises important issues related to the treatment of low back pain (LBP), a condition with major economic and quality of life implications. In this briefing note to the Ontario Ministry of Health regarding the Manga Report (MR), the Ontario Physiotherapy Association (OPA) questions the interpretation of the data and conclusions made by the authors of the report and expresses the belief that further analysis and discussion are required if appropriate health services policy decisions are to be made.     

Supervisors' responses to sickness certification for an episode of low back pain: employees' personal experiences

Purpose.?To understand how work supervisors respond to sickness certification for an episode of low back pain based on employees' reports of employer–employee interactions.

Method.?Thematic analysis of semi-structured in-depth interviews with 16 employees who were currently or had recently been off work with an episode of low back pain.

Results.?Two types of initial supervisor response were identified: See you later and Take your time and get it right. Both of these relied on the employee returning to work once they were able to do their normal work tasks. Three types of subsequent response were identified: Proactive, Apathetic and Negative. Only the proactive response included actions to encourage and assist the employee to return to the workplace.

Conclusions.?The interactions described by participants suggest that employers and their representatives often postpone actioning to return to work interventions which potentially delays the rehabilitation of the employee.     

Effects of chronic smoking on color vision in young subjects

AIM: To evaluate the effects of chronic smoking on color vision in young subjects. METHODS: This study included 91 smokers and 88 non-smokers (a total of 179 volunteers) without any ophthalmologic and systemical disorders. The subjects were between 18-40 years of age with a best corrected visual acuity (BCVA) of 20/20, normal anterior and posterior segment examinations and normal intraocular pressure. The color vision of the subjects were evaluated with Farnsworth-Munsell 100 Hue test (FMHT). The total error scores and axis calculation were performed for each subject and the results correlated. RESULTS: Mean age and the standard deviation was 28±5y in the smokers group, and 26.7±5.5y in the control group (P=0.101). Sex distribution was similar in the two groups (P=0.365). There was no significant correlation between age and FMHT total error scores (P=0.069). Median of FMHT total error scores of smokers and non-smokers were 65 and 50.50, respectively. FMHT total error scores was found significantly higher in smokers than non-smokers (P=0.004). There was no statisticaly significant difference between smoker and non-smoker groups with respect to axis ratio calculation (P=0.611). There was no significant correlation with FMHT total error scores with neither smoking duration nor number of cigarettes smoked per day (P=0.405, P=0.454, respectively). CONCLUSION: This study suggested that chronic smoking affects the color vision of young smokers but this may not be sector selective.     

大学生色觉辨别能力与深度知觉的相关性分析

目的：评价色觉正常大学生的色觉辨别能力与深度知觉的关系。方法：选取巴什肯特大学医学专业学生52例,其中男性33例（63．46％）,女性19例（36．54％）,平均年龄21．18±2．52岁。参与学生视力正常（20／20）,且经Ishihara假同色测试法显示无先天性色觉缺陷。运用Gundogan方法确定主视眼（ DE ）。通过法－孟二氏100色度试验（FM100HT）检验色觉辨别能力,包括左右眼及双眼（TE）的总误差分（ TES ）、部分误差分（ LES ）。误差分分为三组：双眼、DE及非主视眼（ NDE ）。应用TNO检查双眼视觉与立体感,并根据480－15 arc／s范围的立体感水平分为四组。结果：FM100HT的误差分显示无性别差异的TES,蓝黄LES和红绿 LES 分别为61．22±30．32（58．50）[ mean ± SD],35．80±19.32（36．50）和25．42±14．65（24．00）。男性受试者（n＝31）分别为67．45±29．95（61．00）,40．25±18．83（39．00）和27．19±14．30（24．00）。女性受试者（n＝19）分别为51.05±28．84（47．00）,25．52±18．32（28．00）和22．52±31.13（23．00）。根据FM100 HT的误差分,得出女性颜色视觉辨别能力高于男性。通过FM100 HT将色觉辨别能力分为较高（6％,TES＝0～20）,中等（86％,TES＝20～100）和较低（8％, TES＞100）,中等水平最为常见（ P＜0.05）。 DE和NDE的红绿LES 分别为24．12±14．70和32．20±14．21, DE 和 NDE 的蓝黄 LES 分别为34．68±18.95和36．24±17．56。女性（ n＝19） DE和NDE的红绿色LES分别为21．89±15．06和31．00±22．42;男性（ n＝31）则为25．48±14．55和32．93±17．31。女性（ n＝19） DE和NDE 蓝黄色 LES 分别为29．63±18．62和33．42±17.38,男性（ n＝31）则为37．77±18．78和37．96±17．73。所有学生的TE,DE及NDE的TES和立体视觉水平均进行比较,差异均无统计学意义（P＝1）。研究表明色觉辨别能力和双眼深度知觉无关。结论：FM100 HT的TES显示：正常人不同个体立体视觉水平无差异,基于色觉分离的TNO检测的深度直觉与色觉辨别能力不相关。在之前的研究中, DE色觉辨别能力优于NDE。但目前研究表明在深度知觉方面DE并非优于NDE。     

低分子肝素对中国人群脓毒症疗效的Meta分析

目的评价低分子肝素(LWMH)治疗脓毒症的安全性及有效性。方法电子检索万方数据库、维普中文科技期刊全文数据库、中国期刊全文数据库,检索时间为建库至2013年6月,收集LWMH治疗脓毒症患者的临床随机对照试验,研究方法学质量按照Cochrane系统评价员手册进行评定,采用Rev Man 5.0软件进行统计分析。结果共检索到199篇相关文献,经过进一步阅读文献内容后,最终纳入8篇临床随机对照试验,合计449例患者。提取数据后,进行Mete分析。Meta分析结果显示,与对照组相比,LWMH治疗可以降低脓毒症患者的病死率[RR=0.62,95%CI 0.46~0.84,P=0.002];降低患者急性生理学与慢性健康状况评估Ⅱ(APACHEⅡ)评分[加权标准差(WMD)=-1.87,95%CI-2.87~-0.95,P<0.0001];提高患者的D-二聚体水平[加权标准差(WMD)=-0.31,95%CI-0.57~-0.04,P=0.03];增加患者的血小板计数[WMD=15.05,95%CI 10.85~19.25,P<0.00001]。结论 LWMH治疗脓毒症,可以降病死率和APACHEⅡ评分,提高D-二聚体水平和血小板计数。     

低剂量等渗对比剂在640层容积CT冠状动脉CTA中的可行性研究

目的 探讨低剂量等渗对比剂碘克沙醇(320 mgI/mL)在640层容积冠状动脉CT血管成像(CT angiography,CTA)检查中的可行性.方法 将146例行冠状动脉CTA检查的患者分为3组:A组(64例)、B组(45例)和C组(37例),对比剂用量分别为0.6、0.7和0.8 mL/kg.采用主观评价和客观评价两种方法分析比较各组的图像质量.结果 CT值:A组低于B、C组(P＜0.05),但A组血管节段CT值均大于250 HU,能满足诊断要求.SNR及CNR:A组在RCAp、RCAm、RCAd、PDA、LAD-D1、LAD-D2、LCX-OM1、LCXm、LCXd段SNR、CNR明显高于B、C组(P＜0.05);在LM、LADp、LADm、LADd段CNR明显高于B、C组(P＜0.05);在AA段SNR、CNR低于B、C组(P＜0.05);在LADp段SNR A组低于B组,而高于C组(P＜0.05);而在LM、LADm、LADd、LCXp段SNR差异无统计学意义(P＞0.05).图像质量主观评分差异无统计学意义(P＞0.05).结论 640层容积CT冠状动脉CTA检查中,应用320 mgI/mL碘克沙醇0.6 mL/kg,可得到较好的冠状动脉图像质量,并且能减少对比剂用量,降低发生对比剂肾病的风险.