The hemodynamic and pain impact of peripheral nerve block versus spinal anesthesia in diabetic patients undergoing diabetic foot surgery

Clinical Autonomic Research - Comparison of hemodynamic profiles and pain scores in diabetic patients undergoing diabetic foot surgery receiving peripheral nerve block (PNB) or spinal anesthesia...     

Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme

Background

In 2006, 4 years of planning was started by the Ministry of Health, Malaysia (MOH), to implement the HPV (human papillomavirus) vaccination programme. An inter-agency and multi-sectoral collaborations were developed for Malaysia’s HPV school-based immunisation programme. It was approved for nationwide school base implementation for 13-year-old girls or first year secondary students in 2010. This paper examines how the various strategies used in the implementation over the last 7?years (2010–2016) that unique to Malaysia were successful in achieving optimal coverage of the target population.

Methods

Free vaccination was offered to school girls in secondary school (year seven) in Malaysia, which is usually at the age of 13 in the index year. All recipients of the HPV vaccine were identified through school enrolments obtained from education departments from each district in Malaysia. A total of 242,638 girls aged between 12 to 13?years studying in year seven were approached during the launch of the program in 2010. Approximately 230,000 girls in secondary schools were offered HPV vaccine per year by 646 school health teams throughout the country from 2010 to 2016.

Results

Parental consent for their daughters to receive HPV vaccination at school was very high at 96–98% per year of the programme. Of those who provided consent, over 99% received the first dose each year and 98–99% completed the course per year. Estimated population coverage for the full vaccine course, considering also those not in school, is estimated at 83 to 91% per year. Rates of adverse events reports following HPV vaccination were low at around 2 per 100,000 and the majority was injection site reactions.

Conclusion

A multisectoral and integrated collaborative structure and process ensured that the Malaysia school-based HPV immunisation programme was successful and sustained through the programme design, planning, implementation and monitoring and evaluation. This is a critical factor contributing to the success and sustainability of the school-based HPV immunisation programme with very high coverage.

     

The effect of femoral offset modification on gait after total hip arthroplasty

Background and purpose

A decrease of 15% in femoral offset (FO) has been reported to generate a weakness of the abductor muscle, but this has not been directly linked to an alteration of gait. Our hypothesis was that this 15% decrease in FO may also generate a clinically detectable alteration in the gait.

Patients and methods

We performed a prospective comparative study on 28 patients who underwent total hip arthroplasty (THA) for unilateral primary osteoarthritis. The 3D hip anatomy was analyzed preoperatively and postoperatively. 3 groups were defined according to the alteration in FO following surgery: a minimum decrease of 15% (9 patients), restored (14), and a minimum increase of 15% (5). A gait analysis was performed at 1-year follow-up using an ambulatory device. Each limb was compared to the contralateral healthy limb.

Results

In contrast to the “restored” group and the “increased” group, in the “decreased” group there was a statistically significant asymmetry between sides, with reduced range of motion and a lower maximal swing speed on the operated side.

Interpretation

A decrease in FO of 15% or more after THA leads to an alteration in the gait. We recommend 3-D preoperative planning because the FO may be underestimated by up to 20% on radiographs and it may therefore not be restored, with clinical consequences.The femoral offset (FO) and limb length have to be restored during total hip arthroplasty (THA) in order to improve the functional outcomes and to reduce the risk of limping, dislocation (McGrory et al. 1995, Downing et al. 2001, Bourne and Rorabeck 2002, Asayama et al. 2005, Kiyama et al. 2010), and edge loading (Sariali et al. 2010). The restoration of the FO also appears to be crucial to improve the long-term survival rates of THA. Sakalkale et al. (2001) reported that restoration of the FO reduces the wear in THA.With respect to the functional outcomes of THA, a decrease of 15% in FO has been reported to generate weakness of the abductor muscle (Asayama et al. 2005), but this has not been directly linked to an alteration of gait. Indeed, this threshold was defined under laboratory conditions using a CYBEX machine, which does not correspond to realistic activities of daily living. Our hypothesis was that a 15% decrease in the FO may also generate a clinically detectable alteration of gait.Many devices are available for analysis of gait, but most of them are constraining and cannot be used without laboratory conditions (Lamontagne et al. 2011). Some authors have proposed the use of devices for ambulatory gait analysis that can be used for long distances and under realistic daily living conditions (Aminian et al. 2004). For example, the Physilog device (Aminian et al. 2004) has been validated as an evaluation tool for the clinical assessment of patients before and after THA.We analyzed the consequences of an alteration in FO after THA for gait under realistic walking conditions.     

Educating Women for HIV Prevention: Does Exposure to Mass Media Make Them More Knowledgeable?

Mass media is an important vehicle for health promotion in developing countries. In Bangladesh multiple media campaigns are being carried out to educate people about HIV/AIDS. We examined the extent of HIV/AIDS knowledge and the association of exposure to mass media among women in Bangladesh. The Bangladesh Demographic and Health Survey (BDHS) provides data for this article. We found that media exposure (combined index of television, radio, and newspaper) was a highly significant predictor of women's knowledge about HIV and AIDS. Other significant predictors of HIV knowledge include women's education, age, employment, and urban residence.