Falls and other geriatric syndromes in Blantyre,Malawi: a community survey of older adults

Background

The prevalence of geriatric syndromes (falls, immobility, intellectual or memory impairment, and incontinence) is unknown in many resource-poor countries. With an aging population such knowledge is essential to develop national policies on the health and social needs of older people. The aim of this study was to provide a preliminary survey to explore the prevalence of falls and other geriatric syndromes and their association with known risk factors in people aged > 60 years in urban Blantyre, Malawi.

Methods

This was a cross-sectional, community survey of adults aged > 60 years. Subjects were recruited at home or in the waiting areas of chronic care clinics. They were interviewed to complete a questionnaire on age-associated syndromes and comorbid problems. The Abbreviated Mental Test (AMT) and Timed Up and Go (TUG) tests were carried out.

Results

Ninety-eight subjects were studied; 41% reported falling in the past 12 months, 33% of whom (13% of all subjects) were recurrent fallers. Twenty-five percent reported urine incontinence, 66% self-reported memory difficulties, and 11% had an AMT score < 7. A history of falling was significantly associated with urine incontinence (p=0.01), self-reported memory problems (p=0.004) and AMT score < 7 (p=0.02).

Conclusions

Geriatric syndromes, including falls, appear to be prevalent in older people in Blantyre, Malawi. Falling is associated with cognitive impairment and urinary incontinence. There is an urgent need for more understanding of geriatric problems in this setting to develop national policies on health and social needs of older people. It is likely that many of the contributory factors to falls would be amenable to multifactorial interventions similar to those found to be effective in developed countries.     

化学气体污染突发事件中的人群疏散：横断面调查

目的 比较一个塑料工厂发生化学事故后躲藏和被疏散人群的健康结局。设计 横断面调查。背景 英格兰西南的市区。研究对象 该地区1750位曾暴露于化学烟雾的居民，其中472人被疏散，剩下的1278人被建议躲藏在室内。主要结局测定 不利于健康的症状数目。出现4个或以上症状者被确定为一个病例。主要的结果 1096位居民（63％；299人被疏散，797人躲藏起来）为本分析提供了资料。被疏散人群的平均症状分值和病例的比例比躲藏人群的要高（疏散者：症状分值1．9，病例比例19．7％（n=59）；躲藏者：症状分值1．0，病例比例9．5％（n=76），二者比较P〈0．001）。在事故发生后两周末时二组问的差异明显变小。成为病例的两个主要可变更危险因子是疏散（比值比2．5，95％可信区间1．7—3．8）和在事故当天直接暴露于烟雾的时间超过2小时（比值比2．0，95％可信区间1．7—2．3）。住所距工厂的距离或是干预前（头6个小时）暴露的水平对于研究对象成为病例的作用不大。结论 在此次化学事故中躲藏起来可能是优于疏散人群的保护措施。这与专家们普遍认为的观点一致。尽管本研究有一定的局限性，但它是基于一场真实的事件。疏散本身有一定的风险和资源上的限制，认识上的增加可能会有助于减少将来不必要的疏散。     

A cross sectional survey of secondary prevention measures in patients with peripheral arterial disease in primary care

Background

The National Service Framework for coronary heart disease (CHD) defines standards for the secondary prevention of cardiovascular disease in at risk individuals, including those with peripheral arterial disease (PAD).

Aim

To assess current standards of secondary prevention and health monitoring in patients with PAD following a vascular procedure, and additionally compare care in patients with and without diagnosed CHD.

Methods

Indicators for this cross sectional survey were identified from national recommendations and evidence. A retrospective review was conducted of general practitioner records, for patients who were treated in hospital for PAD.

Results

Data were collected for 103 patients from 42 practices. Overall, prescribing was well achieved for antiplatelets but poor for statins. Standards of assessment of blood pressure, smoking status, and smoking cessation advice were high. However, approximately only half of the patients received advice about exercise or had their body mass index checked. Furthermore, for all indicators, standards of care for patients who additionally had a diagnosis of CHD were better than for patients without CHD.

Conclusion

The cross sectional survey suggested the treatment received by some patients with established PAD is substandard. There is considerable potential to increase secondary prevention of CHD in patients with PAD disease in primary care.The National Service Framework for coronary heart disease (CHD)¹ published in 2000 defines national standards for the application of appropriate secondary prevention measures to those at risk of cardiovascular disease, including those with peripheral arterial disease (PAD). Symptoms of coronary artery disease or electrocardiographic abnormality are found in half of patients presenting with PAD, and coronary angiography abnormalities and duplex evidence of carotid artery disease have been found in 90% and 40%, respectively.² Furthermore, PAD has been found to be an independent predictor of increased risk of cardiovascular death. In patients with symptomatic PAD there is a 30% risk of death within 5 years and nearly 50% within 10 years, primarily due to myocardial infarction (MI) (60%) or stroke (12%).² An aggressive approach is therefore required to modify risk factors to reduce the risk of fatal and non‐fatal MI and stroke in patients with PAD.²Currently the management of patients with established CHD is substandard,^3,4 and even when recommendations are implemented there is much variation in the care that patients receive.⁵ Secondary prevention strategies in patients with PAD are likely to be worse than for patients with CHD. For example, a recent study focusing on cholesterol management in general practice showed that patients with stroke or PAD achieved poorer cholesterol control than those with CHD. In this study approximately 50% of patients with PAD and 43% with a stroke had cholesterol values <5 mmol/l compared to 60% of patients with CHD.⁶The objectives of this cross sectional survey were:

• to assess current standards of secondary prevention measures and health monitoring in patients with PAD following a vascular procedure
• to compare standards of secondary prevention in patients with PAD with and without diagnosed CHD.

     

Assessment of internet use and effects among healthcare professionals: a cross sectional survey

Purpose

Several studies have explored the scientific platforms on patient use of the internet for health information. In contrast physicians'' perspective on evolving internet environment is lacking. The purpose of this study is to assess and correlate the extent of internet use among healthcare professionals and examine its effects on clinical practice.

Methods

Cross sectional survey conducted in the USA using questionnaires distributed randomly to healthcare professionals attending distinct continuing medical education programmes between 2003 and 2004. Multiple choice and yes/no questions related to the trends of internet use and its effects on clinical practice were extracted and responses analysed. The main outcome measures are self reported rates of internet use, perceived effects, and the role of medical web sites in clinical practice.

Results

The overall response rate was 60%. A total of 277 survey respondents (97%) had internet access. Some 7% in private practice and 1% of group practice physicians did not have internet access. Most (71%) used the internet regularly for medical or professional updating and 62% (n = 178) felt the need for sharing web sites designed for healthcare professionals with patients. Some 27% of the physicians currently own established personal practice web sites. Sixty three per cent have recommended a web site to a patient for more information, matching the positive trust (>70%) on the general quality of selected medical web sites.

Conclusion

This cross sectional survey shows that internet use and web based medical information is widely popular among physicians and patients. About 23%–31% of the healthcare professionals report >80% interaction with web informed patients in their daily practice.     

Tracheostomy without mechanical ventilation in patients with traumatic brain injury at a tertiary referral hospital in Malawi: a cross sectional study

BackgroundTracheostomy alone, without mechanical ventilation, has been advocated to maintain a free airway in patients with traumatic brain injury in low-income settings with minimal critical care capacity. However, no reports exist on the outcomes of this strategy. We examine the results of this practice at a central hospital in Malawi.MethodsThis is a retrospective review of medical records and prospectively gathered trauma surveillance data of patients admitted to Kamuzu Central Hospital, with traumatic brain injury from January 2010 to December 2015. In-hospital mortality rates were examined according to registered traumatic brain injury severity and airway management.ResultsIn our analysis, 1875 of 2051 registered traumatic brain injury patients were included; 83.3% were male, mean age 32.6 (SD 12.9) years. 14.2% (n=267) of the patients had invasive airway management (endotracheal tube or tracheostomy) with or without mechanical ventilation. Mortality in severe traumatic brain injury treated with tracheostomy without mechanical ventilation was 42% (10/24) compared to 21% (14/68) in patients treated without intubation or tracheostomy (p= 0.043). Tracheostomies had an overall complication rate of 11%.ConclusionTracheostomy without mechanical ventilation in severe traumatic brain injury did not improve survival outcomes in our setting. Tracheostomy for severe traumatic brain injury cannot be recommended when mechanical ventilation is not available unless there are sufficient specialized human resources for follow up in the ward. Efforts to improve critical care facilities and human resource capacity to allow proper use of mechanical ventilation in severe traumatic brain injury should be a high priority in low-income countries where the burden of trauma is high.     

Combination of bleach and flourescent microscopy: a milestone in the diagnosis of smear negative tuberculosis

BACKGROUND: The reliability of direct smear microscopy for diagnosis of tuberculosis has frequently been questioned due to low sensitivity. Treatment of sputum with sodium hypochlorite (NaOCI) has been used to increase sensitivity in many settings. However, no study has established the effect of NaOCI on fluorescent microscopy. OBJECTIVE: To establish whether NaOCI concentration method enhances positivity of fluorescent microscopy smear negative sputum for diagnosis of tuberculosis. DESIGN: A prospective study. SETTING: Mbagathi District Hospital and Centre for Respiratory Diseases Research, Kenya Medical Research Institute. RESULTS: Forty five (22%) specimens were culture positive. Fluorescent microscopy sensitivity was 28.9% and 22.2% after centrifugation and sedimentation with 3.5% NaOCI, respectively (P > 0.05). Sensitivity was 24.4% and 17.8% after centrifugation and sedimentation with 5% NaOCI, respectively (P > 0.05). Although there was no statistical significance difference between the two NaOCI concentration methods, 3.5% NaOCI with centrifugation indicated a higher yield. CONCLUSION: Use of NaOCI significantly enhances positivity of smear negative sputum for diagnosis of tuberculosis when used with fluorescent microscopy. This approach could be recommended for screening all tuberculosis suspects especially in settings with potential smear negative tuberculosis.     

在初级保健中口头提问两项问题筛查抑郁症：横断面研究

目的 确定口头提问两项问题筛查抑郁症的诊断准确性。设计 标准的横断面确认研究。设置 新西兰15家全科诊所。对象 未服用精神药物的421例病人。主要结果的测量与计算机辅助的复合国际诊断访谈比较，两项问题的敏感性、特异性和似然比。结果 两项筛查问题的敏感性和特异性分别是97％(95％可信区间：83％～99％)和67％(62%～72％)，阳性检验似然比为2．9(2．5～3．4)，阴性检验似然比为0．05(0．01～0．35)。病人抑郁症筛查的总阳性率为37％(157／421)。结论 口头提问两项筛查抑郁症的问题能检出全科诊所中的多数抑郁症病例，优点是问题简洁明了。如果医师诊断后，使病人得到治疗的可能性增加，这些问题的效用会更大。     

Predicting commercial success for Australian medical inventions patented in the United States: a cross sectional survey of Australian inventors

OBJECTIVES: To examine the commercial development of Australian medical patents and identify the determinants of their being used in innovations (new or improved products or production processes). DESIGN: Cross-sectional survey with a nested case-control study. PARTICIPANTS AND SETTING: 177 inventors listed as the first Australian on medical patents granted in the United States between 1 January 1984 and 30 December 1994, and surveyed in 1998-1999. MAIN OUTCOME MEASURE: A series of predictor variables (including characteristics of the patents; characteristics of the inventors; ideas, advice and funding during commercialisation; and the process of commercialisation) for whether or not a patent became an innovation. RESULTS: Half (89/177) of the medical patents became innovations, with 34% generating a total of A $287 million (13% over $1 million) in annual sales a median of 8 years after the patent had been granted. A patent was more likely to become an innovation if the inventor was employed by industry at the time of invention (odds ratio [OR], 3.2; 95% CI, 1.1-9.2), had invested their own finances (OR, 2.8; 95% CI, 1.0-7.4), and if the patent had been licensed (OR, 4.6; 95% CI 1.7-12.7), led to further patents (OR, 3.2; 95% CI, 1.0-10.4) and involved an industry partner in its commercial development (OR, 10.1; 95% CI, 3.6-27.7). It was less likely to become an innovation if finance came from a research funding agency (OR, 0.3; 95% CI, 0.1-0.8) and if interest from Australian industry was judged by inventors as "poor" (OR, 0.6; 95% CI, 0.4-0.9). CONCLUSIONS: Medical patents in the US listing Australian inventors are more likely to become innovations if they originate from industry rather than the public sector, and if inventors are willing to invest their own finances.     

儿童饮食行为习惯与肥胖关系的横断面调查——基于上海市闵行区学龄儿童健康的队列研究

 目的  采用横断面调查分析儿童饮食行为习惯与肥胖的关联,为儿童肥胖的预防与干预策略设计提供科学依据。方法  以2014学年上海市闵行区参加体检的公办学校一年级小学生作为研究对象,调查问卷由研究对象的父母或监护人填写,获取研究对象的一般人口学特征、饮食行为习惯、饮食偏好和运动睡眠等日常行为习惯的信息。对调查结果进行非条件Logistic回归分析,计算优势比(odds ratio,OR)和 95%CI。结果   共计5 752名儿童同时进行问卷调查与健康体检,纳入本研究。闵行区一年级学生的肥胖检出率为15.16%,其中男性为18.35%,女性为11.83%;超重检出率为14.31%,其中男性为15.15%,女性为13.43%。平日饮食以荤菜为主(OR=1.58,95%CI:1.32～1.91)、早餐食用频率低(OR=1.87,95%CI:1.01～3.46)、咖啡因食品摄入过多(OR=1.66,95%CI:1.09～2.51)、吃饭速度快(OR:3.32～14.95)等均显著增加了儿童肥胖的危险性;而平日饮食以素菜为主(OR=0.51,95%CI:0.35～0.74)和挑剔食物(OR:0.38～0.64)与较低的儿童肥胖有显著性统计关系。在饮食偏好方面,喜欢吃肉类(OR=2.11,95%CI:1.42～3.14)和腌熏类食物(OR=1.42,95%CI:1.05～1.92)是儿童肥胖的危险因素。结论  不良的饮食行为习惯与儿童肥胖存在关联性。     

普通人群中慢性肾脏病的筛查策略：交叉断面健康调查随访

目的 寻找筛查慢性肾脏病的有效策略，并描述慢性肾脏病的自然病程。 设计 横断面健康调查（HUNTⅡ研究）后的8年随访。 地点 挪威Nord-Trcndelag县。 对象65604人（该国家≥20岁的成年人占70．6％）。主要研究终点指标终末期肾病（ESRD）发生率和心血管事件死亡率，二通过联接到中心登记处的个人信息进行监测。 结果 人群中3069／65604（4．7％）有慢性肾脏病（CKD）（估算肾小球滤过率〈60ml／min／1．73m^2），所以我们每发现1例CKD需要筛查20．6人（95％可信区间20．0—21．2）。筛查患有高血压、糖尿病或年龄〉55岁的人群，其中93．2％（92．4％-94．0％）有CKD，发现1例CKD则需要筛查8．7（8．5—9．0）人。美国KDOQI指南得出相似的筛查结果，英国慢性肾脏病指南的筛查结果仅为51．6％（49．6％-53．4％）。而只筛查既往有明确糖尿病史或高血压病史的人群的结果为44．2％（42．7％-45．7％），每发现1例CKD需要筛查6人。在8年的随访中，3069例CKD患仅有38例进展为终末期肾病；而且，无高血压和糖尿病，女性，年龄≥70岁或筛查时肾小球滤过率（GFR）为45—59ml／min／1．73m。，他们发生ESRD的危险性尤其低。相比而言，心血管事件死亡率则很高，筛查时GFR为45—59，30—44和〈30ml／min／1．73m。的患，其心血管死亡率分别为每100例有3．5，7．4，10．1例死亡。 结论 对有糖尿病，高血压或年龄〉55岁的人群进行筛查是发现CKD患最有效的策略，但是在这些患中发生ESRD的危险性较低。[第一段]     

Serum uric acid level in newly diagnosed essential hypertension in a Nepalese population: A hospital based cross sectional study

Objective

To develop the missing link between hyperuricemia and hypertension.

Methods

The study was conducted in Department of Biochemistry in collaboration with Nephrology Unit of Internal Medicine Department. Hypertension was defined according to blood pressure readings by definitions of the Seventh Report of the Joint National Committee. Totally 205 newly diagnosed and untreated essential hypertensive cases and age-sex matched normotensive controls were enrolled in the study. The potential confounding factors of hyperuricemia and hypertension in both cases and controls were controlled. Uric acid levels in all participants were analyzed.

Results

Renal function between newly diagnosed hypertensive cases and normotensive healthy controls were adjusted. The mean serum uric acid observed in newly diagnosed hypertensive cases and in normotensive healthy controls were (290.05±87.05) µmol/L and (245.24±99.38) µmol/L respectively. A total of 59 (28.8%) participants of cases and 28 (13.7%) participants of controls had hyperuricemia (odds ratio 2.555 (95% CI: 1.549-4.213), P<0.001).

Conclusions

The mean serum uric acid levels and number of hyperuricemic subjects were found to be significantly higher in cases when compared to controls.     

Features associated with underlying HIV infection in severe acute childhood malnutrition: a cross sectional study

Introduction

Up to half of all children presenting to Nutrition Rehabilitation Units (NRUs) in Malawi with severe acute malnutrition (SAM) are infected with HIV. There are many-similarities in the clinical presentation of SAM and HIV. It is important to identify HIV infected children, in order to improve case management. This study aims to identify features suggestive of HIV in children with SAM.

Methods

All 1024 children admitted to the Blantyre NRU between July 2006 and March 2007 had demographic, anthropometric and clinical characteristics documented on admission. HIV status was known for 904 children, with 445 (43%) seropositive and 459 (45%) seronegative. Features associated with HIV were determined.

Results

Associations were found for the following signs: chronic ear discharge (OR 14.6, 95%CI 5.8–36.7), lymphadenopathy (6.4, 3.5–11.7), clubbing (4.9, 2.6–9.4), marasmus (4.9, 3.56.8), hepato-splenomegally (3.2, 1.8–5.6), and oral Candida (2.4, 1.8–3.27). Any one of these signs was present in 74% of the HIV seropositive, and 38% of HIV uninfected children. A history of recurrent respiratory infection (OR 9.6, 4.8–18.6), persistent fever, recent outpatient attendance, or hospital admission were also associated with HIV. Persistent diarrhoea was no more frequent in HIV (OR 1.1). Orphaning (OR 2.1,1.4–3.3) or a household contact with TB (OR 1.7,1.1–2.6), were more common in HIV. Each of these features were present in > 10% of seropositive children. HIV infected children were more stunted, wasted, and anaemic than uninfected children.

Conclusions

Features commonly associated with HIV were often present in uninfected children with SAM, and HIV could neither be diagnosed, nor excluded using these. We recommend HIV testing be offered to all children with SAM where HIV is prevalent.     

重庆市绝经期妇女生殖健康状况的现状调查

目的初步了解我市妇女的绝经期生殖健康保健情况,为进一步开展妇女健康保健工作提供依据.方法我们对2003年6月～2004年6月在我院门诊就诊的重庆地区502名绝经期妇女进行了调查.结果重庆市绝经妇女中自然的平均绝经年龄为48.18岁,自然绝经占94.02%,手术绝经占5.98%.其中在围绝经期和/或绝经期妇女52.99%有潮热、汗多,32.87%有失眠等围绝经期综合征.因有围绝经期症状而使用激素治疗者占28.29%.结论围绝经期和绝经期妇女的健康保健工作应引起高度重视,指导并采取积极有效的措施使中老年妇女的生活质量得到提高.     

广东人群亚健康状态与健康促进生活方式的相关性

目的探讨广东人群亚健康状态与健康促进生活方式的相关性。方法对2012~2013年进行了24 159人（12~80岁）的大 样本、多中心的横断面调查;生活方式的评估使用《健康促进生活方式量表》,健康状况的判定主要结合被调查者的体检报告及 《亚健康评定量表》。结果在24 159名调查对象中,亚健康（46.0%）及疾病（35.2%）人群所占的比例远高于健康者（18.8%）;回 归分析发现健康促进生活方式对健康状态有显著影响（P<0.001）,不良的生活方式是亚健康和疾病的危险因素,且其对亚健康 状态的影响比对疾病的影响更大;在校正一般人口学资料的模型中,相对于优秀的促进健康生活方式（最小暴露者）,差的生活 方式（最高暴露者）发生亚健康的危险性高达43倍（OR：42.825,95% CI：30.567~59.997）,一般的生活方式（较高暴露者）发生亚 健康的危险性高达21 倍（OR：21.072,95% CI：17.258~25.729）,次优的生活方式发生亚健康的危险性为4 倍（OR：4.085,95% CI：3.352~4.979）。且在一般人群中,压力管理差、自我实现差、运动锻炼少、人际关系差是亚健康状态的最主要危险因素。结 论亚健康状态与不良生活方式密切相关;对可改变的生活方式危险因素的组合进行干预,是健康促进的有效方法;将慢性管理 的窗口前移,加强对亚健康状态“窗口”的健康管理至关重要。     

Knowledge and practices towards influenza A (H1N1) among adults in three residential areas in Tampin Negeri Sembilan: a cross sectional survey

A cross-sectional survey was conducted with the objective to explore a community's knowledge and practices towards prevention of Influenza A (H1N1) in three residential areas in Tampin. Respondents were randomly selected from a list of residences and interviewed face-to-face using a structured questionnaire. A total of 221 respondents (80.9%) were involved with the majority (64.7%) comprising female and who had attained secondary level of education (86.0%). The main source of information was from television/radio. The total score for knowledge questions was 15 and practice questions were 25. A total of 60.2% attained "adequate knowledge" and 52.0% "good practice". Mean (SD) for knowledge score was 11.6 (2.3) and practice was 18.1 (4.1). Ethnicity, education, income and practice score were identified as predictors for knowledge score. Income and knowledge scores were predictors for practice score. There was positive correlation between knowledge and practice scores.     

Bacterial colonization of peripheral intravenous cannulas in a tertiary care hospital: A cross sectional observational study

BackgroundThe use of intravenous (IV) cannulas is an integral part of patient care in hospitals. These intravenous cannulas are a potential route for microorganisms to enter the blood stream resulting in a variety of local or systemic infections. Studies showing the actual prevalence of colonization of peripheral IV cannulas and its role in BSI are lacking. Hence, this study was aimed to estimate the prevalence of colonization of the injection ports of peripheral IV cannulas.MethodsThis cross sectional study was conducted on patients admitted in ICU and wards in an 800 bedded tertiary care hospital. Swabs were taken from lumens of peripheral IV cannulas and cultured. Patient demographic data and practices followed for maintenance of IV line were noted.ResultsA total of 196 injection port samples were taken, out of which 11 tested positive for microbial growth (5.61%). Staphylococcus aureus was the predominant organism contributing 64% of the microbial growth. A significant association was seen between presence of local signs, old age and positive cultures. Flushing IV cannula every 6 h was associated with negative cultures.ConclusionPeripheral IV cannulation has significant potential for microbial contamination and is largely ignored. Most of the risk factors associated with growth of microorganisms in the injection ports of peripheral intravenous cannulas (which has a potential to cause catheter-related blood stream infections) can be prevented by improving protocols for management. To prevent infection from occurring, practitioners should be educated and trained about the care and management of IV.     

Prayer in medicine: a survey of primary care physicians

Prayer and spirituality have been shown to have a significant impact on several health variables. Additionally, studies have shown that patients think prayer is important to their health. Very little research, however, has been done to determine primary care physicians' opinions regarding prayer and spirituality as it pertains to healthcare. We surveyed primary care physicians in Mississippi to assess their use of prayer in medical practice. Ninety-one percent of respondents considered prayer an important treatment modality, but 50.6% rarely or never discussed prayer with patients. Most who excluded prayer from clinical practice did so to avoid imposing their beliefs upon patients. A majority of primary care physicians in Mississippi recognize prayer as an important psychosocial variable in assessing and treating patients, but many are hesitant to incorporate this variable into the doctor-patient encounter.     

重庆市血液病实验室质量控制的现状及需求横断面调查研究

目的：了解重庆市血液病实验室质量控制的现状及需求。方法自行设计问卷,抽取重庆市各区县医院60家进行调查,主要调查内容涉及工作基础、规章制度、人员条件等问题。结果共发放60份问卷,有效问卷57份。研究对象中,仅14．04％为血液病专科实验室,大多数都能完成基本检验项目,66．67％有完整实验流程及标准操作规程（SOP）文件,人员以中级职称和本科学历为主。35．08％实验设备超过500万元,45．61％有专人检查记录。约45．61％出检验报告时会参考临床表现,并严格审签,大多数研究对象反应设备落后、人员缺乏,主要希望建立远程会诊系统和开展学习进修。结论重庆市各医院血液病实验室整体质量较好,建议加强全面质量控制,建设血液病应急救援系统,以提升实验室质量和水平。