How sharp is the short QuickDASH? A refined content and validity analysis of the short form of the disabilities of the shoulder, arm and hand questionnaire in the strata of symptoms and function and specific joint conditions

Purpose  

To assess and compare content, validity, and specificity of the QuickDASH (Disability of the arm, shoulder and hand questionnaire) as compared to the full-length DASH and other instruments to give a recommendation for its use depending on a specific clinical situation.     

Analysis of the cost-effectiveness of the implementation of Indoor Residual Spraying and distribution of Long-Lasting Insecticidal Nets in the municipality of Kouandé and municipality of Copargo in Benin

Background

In Benin, malaria was the leading cause of hospital consultation for children less than 5 years old (47.2%), and for all patients not hospitalized (42.3%). Its incidence among those who attended a health facility was respectively 42.9% and 17%. To address this problem, the National Program for the Fight against Malaria undertook, in 2011, a mass campaign of distribution of Long-Lasting Insecticidal Nets (LLINs). In addition to this strategy, the program decided to implement Indoor Residual Spraying in 7 of the 9 municipalities of Atacora department, which is one of the most malaria endemic areas. The objective of this study was to see if adding the IRS to the LLINs (municipality of Kouandé) strategy is cost-effective, as compared to the LLINs-only strategy (municipality of Copargo), in highly malaria endemic areas.

Method

This study was a cross-sectional study of the implementation of the IRS from June 2011 to July 2011. Regarding the selection of health workers, managers of the malaria program, and partners of implementation of the IRS, a reasoned choice was made. The data collection consisted mainly of a series of interviews with people responsible for resource management and the exploitation of documents provided by them.

Results

After the implementation of LLNs + IRS the annual incidence of malaria in health facilities decreased significantly at Kouandé-Centre and at Guilmaro. In the same period it increased significantly at Copargo- Centre, and decreased at Pabégou.The average cost per malaria case prevented (CE) was respectively 85,572.4 FCFA at Copargo Centre, 38,932.6 FCFA at Kouandé Centre, 15,940.6 FCFA at Pabégou and 174,728.5 FCFA at Guilmaro. According to the results, the CE ratio at Kouandé-Centre is lower than the CE ratio at Copargo- Centre and the CE ratio at Guilmaro is higher than the CE ratio at Pabégou.The LLINs?+?IRS strategy is more cost effective in urban areas than the LLINs-only strategy. The opposite result is observed in rural areas.

Conclusion

The LLINs?+?IRS strategy is cost effective in highly endemic areas both urban and rural, if communities sleep in sprayed structures and use LLINs even when it is hot.

     

Characterization of phase I and phase II drug metabolism and the effect of Β-naphthoflavone in the liver and posterior kidney of the channel catfish,Ictalurs punctatus

Immature channel catfish (Ictalurus punctatus) were injected intraperitoneally with 50 mg/kg -naphthoflavone (BNF) and its effects on phase I and phase II xenobiotic metabolizing enzymes of liver and posterior kidney were evaluated. Microsomal monooxygenases in control animals exhibited higher specific activities in liver than in kidney although if data are expressed as turnover numbers, both organs have comparable activities, -naphthoflavone treatment resulted in increases in hepatic microsomal cytochrome P-450 content and ethoxyresorufin deethylase activity. Renal monooxygenases were not responsive to BNF injection. The phase II xenobiotic metabolizing systems of liver or kidney did not respond to BNF treatment. With the exception of epoxide hydrolase which was higher in renal microsomes, phase II drug metabolizing activity of liver cell fractions was about two-fold that observed in fractions isolated from posterior kidney.     

Organisation and financing of the health care systems of Bulgaria and Greece – what are the parallels?

Background  

The Bulgarian and Greek Medical Care systems have been reformated the last fifteen years. The aim of this study was an examination and comparison of the Bulgarian and Greek Medical Care Systems.     

Smoking and the Ø pattern; predictors of transitions through the stages of change

Pre-contemplators, contemplators and preparers have previously been described by distinct scores on pros, social influence and self-efficacy, the ? pattern. The objective of this study was to replicate this pattern in a sample of adult smokers (n = 554), to longitudinally observe stage sequence and identify predictors for forward and backward stage transition. Three hypotheses were formulated: (i) forward transition from pre-contemplation will be predicted by a higher perception of pros concerning smoking cessation, (ii) backward transition from contemplation will be predicted by a lower perception of pros of quitting smoking and (iii) forward transition from preparation will be predicted by a higher self-efficacy perception concerning smoking cessation. The ? pattern was replicated successfully. Smokers appeared to be more likely to transition to an adjacent stage than to skip a stage in the sequence. For prediction of stage transition, separate analyses were conducted for pre-contemplators, contemplators and preparers. Respondents transitioning forward were compared with respondents remaining in the same stage or transitioning backward and vice versa. Hypothesis (i) and (iii) were confirmed. Additionally, self-efficacy predicted forward transition from pre-contemplation. Implications towards improving interventions and research concerning stage transition are discussed.     

Velázquez and the representation of dignity

The purpose of this paper is to explore the visual representation of dignity, through the particular example of the seventeenth century Spanish painter Diego Velázquez. Velázquez works at a point in Western history when modern conceptions of dignity are beginning to be formed. It is argued that Velázquez' portraits of royalty and aristocracy articulate a tension between a feudal conception of majesty and a modern conception of the dignity of merit. On this level, modern conceptions of dignity of merit are understood in terms of a struggle to excel in particular activities, and thus to overcome the risk of failure. More radically, Velázquez' portraits of dwarfs and the mentally disabled are argued to be expressive of dignity, not by finding a positive representation of the sitter's dignity, or to find scales of activities by which they can be positively assessed, but rather by grounding their dignity, negatively, in a protest against indignity and humiliation. Drawing on Honneth's analysis of dignity in terms of a theory of recognition, it is argued that the indignity of the court dwarf lies in the fracturing of their communication with the rest of society. The task of repairing that fractured communication is achieved, not by representing a dignified ideal, but rather by drawing attention to the prejudices that serve to exclude the humiliated from full participation in society. In conclusion, it is suggested that the conceptualisation and representation of the elderly today finds effective exemplars in Velázquez' portraits of court dwarfs, rather than in his portraits of the elderly. This revised version was published online in July 2006 with corrections to the Cover Date.     

Analysis and Forecast of the Mortality of Diabetes Mellitus in China

[目的]分析1990～1999年我国城市和农村居民糖尿病死亡率的现况特点并预测未来5年的变化趋势.[方法]根据<全国卫生统计年报>资料,对我国1990至1999年糖尿病死亡率的现况进行流行病学分析,并利用灰色动态模型GM(1.1)预测我国2000至2005年城市和农村糖尿病死亡率趋势.[结果]城市1999年糖尿病死亡率为15.37/10万而农村为5.13/10万,分别是1990年死亡率的1.89倍和1.71倍;女性的死亡率高于男性,城市和农村男女死亡率之比分别为0.63∶1和0.76∶1;根据1990～1999死亡率所建立的城市的灰色模型预测方程为t=-106.481 7×(1-e0.074 58t)-Yt-1(t=1,2,...,N),而农村的方程为t=-33.605 3×(1-e0.075 37t)-Yt-1(t=1,2,...,N);预测到2005年我国城市和农村糖尿病死亡率将分别达到25.24/10万人和8.15/10万人;精度检验证明了城市和农村的预测模型拟合良好而外推测值可信.[结论]我国人群糖尿病死亡率上升趋势明显,提示有关部门应加强防治力度;灰色模型GM(1.1)能够较好地预测糖尿病死亡率的近期变化趋势.     

Anemia and Micronutrient Status of Women of Childbearing Age and Children 6–59 Months in the Democratic Republic of the Congo

Little is known about the micronutrient status of women and children in the Democratic Republic of the Congo, which is critical for the design of effective nutrition interventions. We recruited 744 mother-child pairs from South Kivu (SK) and Kongo Central (KC). We determined hemoglobin (Hb), serum zinc, vitamin B12, folate, ferritin, soluble transferrin receptor (sTfR), retinol binding protein (RBP), C-reactive protein, and α-1 acid glycoprotein concentrations. Anemia prevalence was determined using Hb adjusted for altitude alone and Hb adjusted for both altitude and ethnicity. Anemia prevalence was lower after Hb adjustment for altitude and ethnicity, compared to only altitude, among women (6% vs. 17% in SK; 10% vs. 32% in KC), children 6–23 months (26% vs. 59% in SK; 25% vs. 42% in KC), and children 24–59 months (14% vs. 35% in SK; 23% vs. 44% in KC), respectively. Iron deficiency was seemingly higher with sTfR as compared to inflammation-adjusted ferritin among women (18% vs. 4% in SK; 21% vs. 5% in KC), children 6–23 months (51% vs. 14% in SK; 74% vs. 10% in KC), and children 24–59 months (23% vs. 4% in SK; 58% vs. 1% in KC). Regardless of indicator, iron deficiency anemia (IDA) never exceeded 3% in women. In children, IDA reached almost 20% when sTfR was used but was only 10% with ferritin. Folate, B12, and vitamin A (RBP) deficiencies were all very low (<5%); RBP was 10% in children. The prevalence of anemia was unexpectedly low. Inflammation-adjusted zinc deficiency was high among women (52% in SK; 58% in KC), children 6–23 months (23% in SK; 20% in KC), and children 24–59 months (25% in SK; 27% in KC). The rate of biochemical zinc deficiency among Congolese women and children requires attention.     

Does the Type of Provider and the Place of Residence Matter in the Utilization of Prenatal Ultrasonography? Evidence from Canada

Background

There has been a proliferation of repeat prenatal ultrasound examinations per pregnancy in many developed countries over the past 20 years, yet few studies have examined the main determinants of the utilization of prenatal ultrasonography.

Objective

The objective of this study was to examine the influence of the type of provider, place of residence and a wide range of socioeconomic and demographic factors on the frequency of prenatal ultrasounds in Canada, while controlling for maternal risk profiles.

Methods

The study utilized the data set of the Maternity Experience Survey (MES) conducted by Statistics Canada in 2006. Using an appropriate count data regression model, the study assessed the influence of a wide range of socioeconomic, demographic, maternal risk factors and types of provider on the number of prenatal ultrasounds. The regression model was further extended by interacting providers with provinces to assess the differential influence of types of provider on the number of ultrasounds both across and within provinces.

Results

The results suggested that, in addition to maternal risk factors, the number of ultrasounds was also influenced by the type of healthcare provider and geographic regions. Obstetricians/gynaecologists were likely to recommend more ultrasounds than family physicians, midwives and nurse practitioners. Similarly, birthing women who received their care in Ontario were likely to have more ultrasounds than women who received their prenatal care in other provinces/territories. Additional analysis involving interactions between providers and provinces suggested that the inter-provincial variations were particularly more pronounced for family physicians/general practitioners than for obstetricians/gynaecologists. Similarly, the results for intra-provincial variations suggested that compared with obstetricians/gynaecologists, family physicians/GPs ordered fewer ultrasound examinations in Prince Edward Island, British Columbia, Nova Scotia, Alberta and Newfoundland.

Conclusion

After controlling for a number of socioeconomic and demographic factors, as well as maternal risk factors, it was found that the type of provider and the province of prenatal care were statistically significant determinants of the frequency of use of ultrasounds. Additional analysis involving interactions between providers and provinces indicated wide intra- and inter-provincial variations in the use of prenatal ultrasounds. New policy measures are needed at the provincial and federal government levels to achieve more appropriate use of prenatal ultrasonography.     

Estimation of the dog and cat population in the State of São Paulo

OBJECTIVE: To estimate the total dog and cat population with owners in order to enable better planning of the control actions against diseases involving these animals. METHODS: The study was carried out in the non-metropolitan regions of the State of S?o Paulo, Brazil, from May to December 2002. Forty-one municipalities and 100 census tracts were surveyed. These were selected by probabilistic stratified cluster sampling in two stages. The strata were formed by grouping the municipalities according to their populations and living conditions. The Pasteur S?o Paulo Technique was used to obtain data on the canine population. This technique was developed to estimate and classify dogs according to their degree of dependence and restriction. RESULTS: Almost 53% of the 20,958 households visited owned a dog, and the average was 1.6 dogs per household. A total of 4,624 cats were found, concentrated in 12.6% of the households. The results indicate a dog/inhabitant ratio of 1:4.0 and a cat/inhabitant ratio of 1:16.4. CONCLUSIONS: The animal/inhabitant ratios were much higher than expected. Incorporation of these ratios into evaluations of the vaccination campaign against rabies has revealed more realistic coverage patterns, thus leading to renewed discussion of the vaccination targets for municipalities. An association was observed between the size of the municipality or its inhabitant's living conditions and the level of restrictions on dogs.     

Blood, sweat and semen: the economy of axé and the response of Afro-Brazilian religions to HIV and AIDS in Recife

This article provides an ethnographic analysis of Afro-Brazilian religious responses to the HIV epidemic in Recife. Drawing on participant observation and in-depth interviews conducted with Afro-Brazilian religious leaders and public health officials, it highlights the importance of the axé--a mystical energy manipulated in religious rituals that is symbolically associated with blood, sweat and semen. In an analysis of the relationship formed between the state AIDS programme and Afro-Brazilian religious centres, we conclude that the recognition of native categories and their meanings is one of the key elements to a fruitful dialogue between public health programmes and religious leaders that in the case studied, resulted in the re-signification of cultural practices to prevent HIV. Although the Afro-Brazilian religious leaders interviewed tended to be more open about sexuality and condom promotion, stigma towards people living with HIV (PLHIV) was still present within the religious temples, yet appeared to be more centred upon the perception of HIV as negatively affecting followers' axé than judgement related to how one may have contracted the virus. We discuss the tensions between taking a more liberal and open stance on prevention, while also fostering attitudes that may stigmatise PLHIV, and make suggestions for improving the current Afro-Brazilian response to the epidemic.     

How are new refugees doing in Canada? Comparison of the health and settlement of the Kosovars and Czech Roma

BACKGROUND: In 1999, a group of Kosovars arrived in Hamilton, Ontario, with a coordinated international pre-migration plan, as part of the United Nations Humanitarian Evacuation Program. Since 1997, a substantial number of Roma refugees from the Czech Republic also arrived in Hamilton, with no special pre-migration planning. This study examined whether the organized settlement efforts led to better adaptation and perceived health for the Kosovars, using the Czech Roma as a comparison group. METHODS: Adult members of 50 Kosovar (n=157 individuals) and 50 Czech Roma (n=76 individuals) randomly selected families completed a questionnaire on sociodemographics, health, well-being, and perceived adaptation to Canada. Differences between groups were examined using univariate and multivariate analyses. Comparison was made to the Ontario population where possible. RESULTS: There were more Kosovars than Czech Roma over the age of 50 (22.1% vs 10.5%, p=0.03). Nearly one quarter (21.7%) of the Kosovars had a score indicating post-traumatic stress disorder (PTSD) on the Harvard Trauma Questionnaire (HTQ), compared to none of the Roma (p<0.001). After adjustment for age and PTSD, the Kosovars were significantly more likely to report fair or poor adaptation to Canada (OR=10.5, 95% CI=3.6-31.2) and that life is somewhat or very stressful (OR=3.9, 95% CI=2.1-7.4). Differences for other measures were no longer significant after adjustment. CONCLUSIONS: The health and adaptation of the Kosovars was not better than that of the Czech Roma. Reasons for this finding may include differences in demographics, the presence of PTSD, and differing length of time since arrival in Canada.