Cripples at the medieval hospital of Bátmonostor, Hungary--archeological findings

Cripples from the medieval hospital of Bátmonostor, Hungary. People with disabilities were generally burdened with a painful fate in ancient times, however in the hospitals was no effective therapy. The hospital of Batmonostor was founded at late 13th century, The authors examine by morphological, radiological and histological methods 426 complete skeletons excavated from medieval (14th-15th century) cemetery of Bátmonostor (Hungary). Among them 30 cases (7.1%) of bony ankylosis, (24 cases on lower limb and 6 cases on upper limb) was found. Sacroiliac ankylosis 3 cases, Bechterew's spondylitis ankylopoetica 1 case was seen. Spondylitis tuberculosa and malum Potti 4 cases, and hunchback with other aetiology 2 cases was detected. Beside the cases with ankylosis severe posttraumatic osteomyelitis (7 cases), primary malignant bone tumors (2 cases) and an osteoplastic metastatic tumors (probably prostata carcinoma) was diagnosed. Paleopathologic study of the physically disabled may yield information and insight on the prevalence of crippling disorders. The authors hypothetize, that crippled persons lived in the hospital until their deaths.     

Triple jeopardy? Mental health at the intersection of gender,race, and class

Structural theories of stratification predict that groups with low positions in social hierarchies experience high rates of mental health problems. Extensions of this approach such as a triple jeopardy hypotheses claim that groups that are subordinate in multiple stratification systems such as gender, race and class are at especially high risk. Multiple minority statuses affect mental health in paradoxical ways, however, that refute triple jeopardy approaches. This paper presents a theoretical perspective based in cultural as well as structural theories that offers an alternative to triple jeopardy. I predict that certain relational schemas are jointly shaped by gender, race, and class and help explain their anomalous effects on mental health. These schemas of self-salience refer to beliefs about the relative importance of the self and others in social relations; they affect mental health by forming subjective alternative hierarchies to larger societal stratification systems. I use secondary analyses of two U.S. data sets to investigate this perspective. Results of regression analysis show that self-salience helps explain the paradoxical patterns of mental health by gender, race, and social class. The findings underscore the importance of using an intersectional approach and integrating cultural and structural factors to understand how stratification shapes mental health.     

Secondary Standard Dosimetry Laboratory at the Ruder Bosković Institute, Zagreb

The Secondary Standard Dosimetry Laboratory at the Ruder Boskovi? Institute (SSDL), Zagreb, Croatia, was set up over the last few years with a strong support by the International Atomic Energy Agency (IAEA) through the Technical Cooperation Project CRO/1/004, Establishing Calibration Services. The SSDL occupies two calibration rooms, each 9.6 m long and 6 m wide and each with proper air conditioning. Their walls are concrete and 1 m thick, and the entrance doors are plated with lead to protect the control rooms and the surroundings against radiation. In the first calibration room in the basement, there are two sealed sources which share the same, 6 m long calibration bench. A 30 TBq 60Co source on one side of the bench is used for calibrating ionising chambers and other high-dose radiation equipment. The irradiation unit on the other side of the bench combines two sealed sources, that is, a 740 MBq 137Cs source and a 185 MBq 60Co source, and is used for radiation protection purposes. It has three attenuators with nominal attenuations of x10, x100, and x1000. The second calibration room, which is just above the first, accommodates an X-ray unit (ISOVOLT 420, 40 kV to 300 kV, 1 mA to 20 mA) with a 5 m long calibration bench, aperture wheel assembly designed to modify the X-ray beam diameter to meet various configuration requirements for calibration instruments, a set of filter assemblies to control beam definition according to ISO 4037-3, and a half-value layer kit.     

Medical humanities: stranger at the gate,or long-lost friend?

“Medical humanities” is a phrase whose currency is wider than its agreed meaning or denotation. What sort of study is it, and what is its relation to the study of philosophy of medicine? This paper briefly reviews the origins of the current flowering of interest and activity in studies that are collectively called “medical humanities” and presents an account of its nature and central enquiries in which philosophical questions are unashamedly central. In the process this paper argues that the field of enquiry is well-conceived as being philosophical in character, and as having philosophy — albeit pursued over a larger canvas — at the core of its contributing humanities disciplines. The paper characterises humanities disciplines as having an important focus on human experience and subjectivity, of which the experiences and subjectivities at stake in health, medicine and illness form an important sub-set, the preoccupation of the medical humanities as a whole. Claims of interdisciplinarity (as distinct from multidisciplinarity) are noted, but such claims need to be recognised for the high and stern ambition that they embody, and should not be made lightly.     

Acupuncture Use in the United States: Who,Where, Why,and at What Price?

Despite the increase in acupuncture uses and greater than ever before interest of funding agencies to fund biomedical research in acupuncture, little is known about the profile of acupuncture users. We examined who these individuals are, where they reside, why they use acupuncture, and what price they pay. The increased use and high costs associated with each acupuncture visit poses questions to health care insurers regarding its coverage. Profiling will help conventional providers identify the segment of the population who are more likely to use acupuncture and educate them on the possible risks and benefits of using it with conventional medicine.     

Investigation and Control of Anthrax Outbreak at the Human–Animal Interface,Bhutan, 2010

In 2010, we investigated anthrax outbreak in Bhutan. A total of 43 domestic animals died, and cutaneous anthrax developed in 9 persons, and 1 died. All affected persons had contact with the carcasses of infected animals. Comprehensive preparedness and response guidelines are needed to increase public awareness of anthrax in Bhutan.     

Pediatric salmonellosis at the Tokoin's teaching hospital, Lomé (Togo)

OBJECTIVE: The authors had for aim to describe the epidemiological, clinical, and bacteriological aspects and outcome of pediatric Salmonella enterica, Salmonella septicemia, over the last 10 years. PATIENTS AND METHODS: We analyzed the case history of 132 patients hospitalized for Salmonellasepticemia (positive blood culture) between 1995 and 2004. RESULTS: Salmonellosis accounted for 0.36% of all hospitalizations. The mean age of patients was 5.86 plus or minus 4.06 years, significantly higher in patients with S. ser. Typhi (7.14+/-4.04 years) than in patients with other serotypes (4.95+/-3.8 years). The clinical presentation was severe in many children (with dehydration (34.8%) and emaciation (55.3%)), so HIV was suspected and investigated in 51 patients (38.6%). Eight patients were HIV positive. Three serotypes of S. enterica were predominant: S. ser. Typhi, 55 cases (41.7%), S. ser. Enteritidis, 32 cases (24.2%), and S. ser. Typhimurium, 19 cases (14.4%). The bacterial susceptibility to antibiotics was good for ceftriaxone and ciprofloxacin (100%). But 78.8% of the serotypes were resistant to amoxicillin, 75.4% to chloramphenicol, and 69.4% to cotrimoxazole. The mean duration of hospitalization was 13.7 plus or minus 7.4 days (range 4-34 days). Complications occurred in 15.9% of cases, dominated by digestive bleeding (10.6%), and 6.1% of patients died.     

Exposure to famine during gestation, size at birth, and blood pressure at age 59 y: evidence from the dutch famine

We compared blood pressure of individuals (mean age 59 y) born in western Holland between January 1945 and March 1946 (mothers exposed to the Dutch Famine before or during gestation; n = 359) to blood pressure of unexposed individuals born before or conceived after the famine (n = 299) or same-sex siblings of subjects in series 1 or 2 (n = 313). Mean (SD) systolic and diastolic blood pressure were 140.3 (20.3) and 85.8 (11.0) mmHg, respectively; prevalence of hypertension (prior diagnosis of hypertension or with measured systolic/diastolic blood pressure above 140/90 mmHg) was 61.8%. Birth weight was inversely related to systolic (−4.14 mmHg per kg; 95% confidence interval (CI) −7.24, −1.03; p < 0.01) and diastolic (−2.09 mmHg per kg; 95% CI −3.77, −0.41; p < 0.05) blood pressure and to the prevalence of hypertension (odds ratio 0.67 per kg, 95% CI: 0.49, 0.93) (all age- and sex-adjusted). Any famine exposure of at least 10 weeks duration was associated with elevated systolic (2.77 mmHg; 95% CI 0.25, 5.30; p < 0.05) and diastolic (1.27 mmHg; 95% CI −0.13, 2.66; p = 0.08) blood pressure and with hypertension prevalence (odds ratio 1.44; 95% CI 1.04, 2.00; p < 0.05) in age- and sex-adjusted models. Exposure to famine during gestation may predispose to the development of hypertension in middle age.     

Sunshine and suicide at the tropic of Capricorn, São Paulo, Brazil, 1996-2004

Several studies have confirmed seasonal variation in suicide rates according to hours of sunshine. The suicide pattern was assessed in S?o Paulo, southeastern Brazil, at the tropic of Capricorn from 1996 to 2004. Poisson regression was employed to estimate parameters of seasonality, as well as to verify associations for each day between daylight duration and suicide. During the nine-year study period, there were 3,984 suicides (76.9% in men; median age=38.7 years old). Seasonal averages of suicides were similar, as were monthly averages. Poisson regression did not reveal any association between suicide rates and hours of sunshine (p=0.45) for both sexes. In conclusion, no seasonal pattern was observed for suicides.     

Descriptive analysis of diabetes-related amputations at the Colonial War Memorial Hospital,Fiji, 2010–2012

Setting: The Colonial War Memorial Hospital (CWMH) in Fiji.Objective: To determine the characteristics of patients with diabetes mellitus (DM) who underwent lower limb amputations at the CWMH from 2010 to 2012.Design: This was a retrospective review of data contained in operating theatre registers and clinical records of DM patients who had undergone amputations during the study period.Result: Of the 938 amputations performed at the CWMH during the study period, significantly more patients were male than female (54.1% vs. 45.9%) and more i-Taukei (indigenous Fijian) than Indo-Fijian (71% vs. 26.2%); 15.9% of patients had not previously been diagnosed as having DM when they presented with foot sepsis. The rate of smoking was highest in male i-Taukei patients. A large proportion of patients (76.8%) had poor glycaemic control.Conclusion: This study suggests that male i-Taukeis are most at risk, and that uncontrolled DM is a significant factor associated with amputations. There is a need to strengthen DM screening and improve glycaemic control. Foot care education needs to be implemented at diagnosis and re-enforced with regular clinic visits and complication screening sessions.     

Health equity issues at the local level: Socio-geography,access, and health outcomes in the service area of the Hôpital Albert Schweitzer-Haiti

Background

Although health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. Here, we describe here a comprehensive equity assessment carried out by the Hôpital Albert Schweitzer-Haiti (HAS) in 2003. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years.

Methods

We reviewed all available information arising from a comprehensive evaluation of the programs of HAS carried out in 1999 and 2000. As part of this evaluation, two demographic and health surveys were carried out. We carried out exit interviews with clients receiving primary health care, observations within health facilities, interviews with households related to quality of care, and focus group discussions with community-based health workers. A special study was carried out in 2003 to assess factors determining the use of prenatal care services. Finally, selected findings were obtained from the HAS information system.

Results

We found markedly reduced access to health services in the peripheral mountainous areas compared to the central plains. The quality of services was more deficient and the coverage of key services was lower in the mountains. Finally, health status, as measured by under-five mortality rates and levels of childhood malnutrition, was also worse in the mountains.

Conclusion

These findings indicate that local health programs need to give attention to monitoring the health status as well as the quality and coverage of basic services among marginalized groups within the program service area. Health inequities will not be overcome until such monitoring occurs and leaders of health programs ensure that inequities identified are addressed in the local programming of activities. It is quite likely that, within relatively small geographic areas in resource-poor settings around the world, similar, if not even greater, levels of health inequities exist. These inequities need to be measured and addressed in order for health programs to achieve equity and maximum improvement in health status within the population.