Temporal Changes of Access to Primary Health Care in Illinois (1990–2000) and Policy Implications

This paper examines temporal changes of access to primary health care in Illinois between 1990 and 2000 in a Geographic Information System (GIS) environment. Census data at the census tract level in 1990 and 2000 were used to define the population (demand) distribution and related socioeconomic attributes, and the Physician Masterfile of American Medical Association in corresponding years was used to define the physician (supply) distribution at the zip code level. A two-step floating catchment method was employed to measure the spatial access, considering locations of physicians and population and travel times between them. Various socioeconomic and demographic variables were consolidated into three factors (i.e., socioeconomic disadvantages, sociocultural barriers, and high healthcare needs) for measuring the nonspatial access. Spatial and nonspatial factors were finally integrated together to assess the primary care physician shortage areas. The study shows that spatial accessibility to primary care physician for the majority of the state improved from 1990 to 2000. Areas with worsened spatial accessibility were primarily concentrated in rural areas and some limited pockets in urban areas. The worst among these worsened areas appeared to be associated with populations with high scores of socioeconomically disadvantages, sociocultural barriers, and healthcare needs. Improving the accessibility of those socioeconomically disadvantaged population groups is critical for the success of future policies.     

The effects of Valsalva maneuver on venipuncture pain in children: comparison to EMLA® (lidocaine–prilocaine cream)

Background

Venipuncture is one of the most painful events for children in hospitals. Valsalva maneuver (VM) decreases the incidence and severity of pain on venipuncture pain in adults. This study was designed to evaluate VM as compared with Eutectic Mixture of Local Anesthetic (EMLA^®) cream for venipuncture pain in children.

Method

In this study, we evaluated the effect of VM on venipuncture pain in children. 60 patients scheduled for elective surgery were randomly divided into three groups. In Group V, children were punctured during VM. In Group E, EMLA^® 5 % cream and in Group C (control group) vaseline was applied on the non-dominant hand 60 min before the venipuncture. Patients made a pain assessment using visual analog score (VAS). Mean arterial pressure (MAP), heart rate (HR), and SpO₂ measurements were obtained during the venous cannulation.

Results

Respectively, the VAS was 2.15 ± 1.95 for Group V and 1.00 ± 0.79 for Group E and 2.55 ± 2.74 for Group C. A significant reduction in the severity of pain was observed in Group E. The difference being statistically significant (p < 0.05), the VAS of Group V was higher than Group E but lower than Group C (p > 0.05).

Conclusions

On the basis of data from this study, the VM is a simple and a practical method to reduce venipuncture pain in children but not as effectively as EMLA^®.     

An active serological survey of antibodies to newcastle disease and avian influenza (H9N2) viruses in the unvaccinated backyard poultry in Bushehr province,Iran, 2012–2013

ObjectiveTo test the antibodies against newcastle disease virus (NDV) and avian influenza virus (AIV, H9N2) in the unvaccinated backyard poultry in Bushehr province, Iran from 2012 to 2013.MethodsA total of 1 530 blood samples from unvaccinated backyard chickens in Bushehr province, south of Iran, were tested for antibodies against NDV and AIV (H9N2) by hemagglutination inhibition test according to International Epizootic Office (OIE) recommendation.ResultsOf these, 614 (40.13%) and 595 (39.00%) were positive for NDV and AIV (H9N2) respectively.ConclusionsThe findings of the present study indicated that NDV and AIV (H9N2) were endemic and widely distributed in backyard areas of Bushehr province which should be incorporated in the control strategies. Further studies are needed to identify the circulating virus genotypes, model their transmission risk, provide adapted control measures and design proper and applicable vaccination program.     

Post-Marketing Surveillance of Qishe Pill (芪麝丸) Use for Management of Neck Pain in a Chinese Patient Cohort to Determine Its Safety, Tolerability and Effectiveness

Objective: To evaluate the safety and effectiveness of Qishe Pill (芪麝丸) on neck pain in real world clinical practice. Methods: A multi-center, prospective, observational surveillance in 8 hospitals across Shanghai was conducted. During patients receiving 4-week Qishe Pill medication, Visual Analogue Scale (VAS) and Neck Disability Index (NDI) assessments have been used to assess their pain and function, while safety monitoring have been observed after 2 and 4 weeks. Results: Results from 2,023 patients (mean age 54.5 years) suggest that the drug exposure per unit of body mass was estimated at 3.41± 0.62 g/kg. About 8.5% (172/2,023) of all participants experienced adverse events (AEs), while 3.8% (78/2,023) of all participants experienced adverse reaction. The most common AEs were gastrointestinal events and respiratory events. The VAS score (pain) and NDI score (function) significantly decreased after 4-week treatment. An effect-quantitative analysis was also conducted to show that the normal clinical dosage may be consider as 3–4 g/kg, at which dosage the satisfactory pain-relief effect may achieve by 40-mm reduction in VAS. Conclusion: These findings showed that patients with cervical radiculopathy who received Qishe Pill experienced significant improvement on pain and function. (Registration No. NCT01875562)     

Correlation between anthropometric measurement,lipid profile,dietary vitamins,serum antioxidants,lipoprotein (a) and lipid peroxides in known cases of 345 elderly hypertensive South Asian aged 56–64 y–A hospital based study

ObjectiveTo address the association of dietary vitamins, anthropometric profile, lipid profile, antioxidant enzymes and lipid peroxidation in hypertensive participant compared with normotensive healthy controls.MethodsDietary intake of vitamins was assessed by 131 food frequency questionnaire items in both hypertensive participants and normotensive age-sex matched healthy controls. The associated changes in serum antioxidants and lipid peroxidation were also assessed along with lipid profile and anthropometric measurements in both groups of subjects under study.ResultsDietary vitamins intake was higher in hypertensive participants excepting for vitamin B2 and ascorbic acid compared to normotensive controls. Anthropometric variables in the hypertensive showed significant differences in weight, body mass index, waist circumference, hip circumference, waist-hip ratio and mid-arm circumference. The total cholesterol, low-density lipoprotein cholesterol, triglyceride were significantly higher (P<0.001) in hypertensive except high-density lipoprotein cholesterol which was significantly higher (P<0.001) in normotensive. The serum endogenous antioxidants and enzyme antioxidants were significantly decreased in hypertensive except serum albumin levels compared to normotensive along with concomitant increase in serum lipoprotein (a) malondialdehyde and conjugated diene levels.ConclusionsBased on the observations, our study concludes that hypertension is caused due to interplay of several confounding factors namely anthropometry, lipid profile, depletion of endogenous antioxidants and rise in oxidative stress.     

Inhibitory effect of polyphenolic–rich extract from Cola nitida (Kolanut) seed on key enzyme linked to type 2 diabetes and Fe2+ induced lipid peroxidation in rat pancreas in vitro

ObjectiveTo investigate the inhibitory effect of phenolic-rich extracts from Cola nitida (C. nitida) seeds on key enzymes linked with type-2 diabetes and Fe²⁺ induced oxidative stress in rat pancreas.MethodsThe phenolic extract was prepared with 80% acetone (v/v). Subsequently, the antioxidant properties and inhibitory effect of the extract on α – amylase and α – glucosidase as well as on Fe²⁺ induced lipid peroxidation in rat pancreas were determined in vitro.ResultsThe result revealed that C. nitida extract inhibited α-amylase (EC₅₀=0.34 mg/mL) and α-glucosidase (EC₅₀=0.32 mg/mL) activities as well as Fe²⁺ induced lipid peroxidation in rat pancreas in a dose dependent manner. In addition, the extract had high DPPH radical scavenging ability (EC₅₀=2.2 mg/mL) and reducing power (8.2 mg AAE/g). Characterization of the main phenolic compounds of the extract using gas chromatography analysis revealed catechin (6.6 mg/100 g), epicatechin (3.6 mg/100 g), apigenin (5.1 mg/100 g) and naringenin (3.6 mg/100 g) were the main compounds in the extract.ConclusionsThis antioxidant and enzyme inhibition could be some of the possible mechanism by which C. nitida is use in folklore for the management/treatment of type-2 diabetes. However, the enzyme inhibitory properties of the extract could be attributed to the presence of catechin, epicatechin, apigenin and naringenin.     

Emerging evidence for Gleason grade migration and distance impact in prostate cancer? An analysis of the rapid access prostate clinic in a tertiary referral center: St. Vincent’s University Hospital, Dublin (2009–2011)

Background

Recent evidence has suggested that the introduction of rapid access prostate cancer programs has led to a more streamlined pathway for patients, and was designed to ultimately reduce referral delays

Aims

To identify the initial impact of the introduction of the rapid access prostate clinic on Gleason grading within the prostate cancer cohort, as well as the impact of distance from a tertiary referral center on subsequent Gleason grading

Methods

A prospective database was maintained from those men attended the rapid access prostate clinic in St. Vincent’s University Hospital. Data relating to demographics, biopsy results, retrospective PSA readings, and subsequent treatment pathways were all recorded and analyzed. Statistical significance was taken at p < 0.05

Results

Prospective data from the rapid access prostate clinic illustrated similar results in patient demographics, Gleason grade and choice of treatment outcomes to other published institutions, however, for the first time demonstrate emerging evidence of the effect of the rapid access prostate clinic leading to a downward shift in Gleason grade over a 2-year period, as well as data showing an inverse correlation between leading Gleason grade and distance from our tertiary referral center

Conclusion

These results suggest that the introduction of the rapid access prostate clinic has initially begun to demonstrate an initial downgrading in Gleason scoring patterns. Our data also reflects a poorer Gleason score in those patients living further away from the rapid access prostate clinic. This may be in part attributed to a surge in referrals of those patients previously managed outside a tertiary institution, and suggests that patients should undergo prompt referral following suspicion for prostate cancer