Do Referrals Work? Responses of Childbearing Newcomers to Referrals for Care

Background Health care post-birth may include referrals for additional care. Migrant (i.e., refugee, asylum-seeker, and immigrant) women frequently do not follow-up referrals for care and could be at increased health risk as a consequence. We sought to explore the inhibitors and facilitators of migrant women for following through with referrals for care. Methods Twenty-five women living in Montreal who had received a referral completed semi-structured interviews. Results Inhibitors included language barriers, transportation problems, scheduling appointments, absence of husband, absence of childcare, cold weather, perceived inappropriate referrals, and cultural practice differences. Facilitators included choice of follow-up facilitator, appropriate services, empathetic professionals, and early receipt of information. Discussion Results indicate that migrant women may not be receiving the care they and their newborns need once a concern is identified. This suggests conceiving of a different approach to the care of this population post-birth, which could include partnering with social or religious networks.     

Melatonin-loaded lecithin/chitosan nanoparticles: Physicochemical characterisation and permeability through Caco-2 cell monolayers

In this study, the potential of lecithin/chitosan nanoparticles (NPs) as a mucoadhesive colloidal nanosystem for transmucosal delivery of melatonin was investigated. The size, zeta potential and melatonin loading of the lecithin/chitosan NPs were investigated as a function of lecithin type (Lipoid S45, S75 and S100) and chitosan content in the preparation. The NPs were characterised by mean diameter and zeta potential ranging between 121.6 and 347.5 nm, and 7.5 and 32.7 mV, respectively, and increasing with lecithin-negative charge and chitosan content in the preparation. Melatonin loadings were up to 7.1%. All NPs were characterised by prolonged release profiles with an initial burst (approximately 25%), followed by a slow release phase. Approximately 60–70% of melatonin was released in 4 h. The permeability of melatonin was investigated using Caco-2 cells as an in vitro model of the epithelial barrier. Melatonin permeability from an NP suspension prepared with Lipoid S45 lecithin and a lecithin-to-chitosan weight ratio (L/C) of 20:1 (sample C2) was significantly improved compared to the permeability of melatonin from the solution (P < 0.001) and from all other NPs investigated (P < 0.05). The results obtained by the cell viability studies (MTT and LDH leakage assays) showed that C2 NP suspension did not induce plasma membrane damage or decrease cell viability and could be safely applied to Caco-2 cells in the concentration range tested (<400 μg/ml).     

Atelectasis on pediatric chest CT: comparison of sedation techniques

Background. A change in practice at our institution resulted in increased use of anesthesia for CT scan of the chest in children who required sedation. Objective. To determine whether there is a difference in the frequency or severity of pulmonary atelectasis on CT scan in children sedated by anesthesiologists compared with children sedated by radiologists using intravenous pentobarbital. Materials and methods. Retrospective blinded review of 60 CT scans of the chest performed in 41 children. Forty-one studies in children sedated by radiologists (median age 29 months) were compared with 19 studies in children sedated by anesthesiologists (median age 25 months). Results. Atelectasis sufficient to obscure pulmonary metastases was shown in 5 of 41 (12 %) radiology sedations and 13 of 19 (68 %) anesthesiology sedations (P < 0.01). Higher grades of atelectasis were recorded in children under anesthesia (P < 0.01). Conclusion. Atelectasis is more frequent and more severe in children undergoing general anesthesia compared with intravenous pentobarbital sedation. Consideration should be given to the use of forced inspiration in children anesthetized for CT scan of the chest. Received: 31 July 1998 Accepted: 2 February 1999     

Perioperative coronary spasm and right ventricular ischemia

Perioperative coronary spasm after coronary bypass surgery is increasingly recognized as a possible cause of circulatory collapse. Most of the reported cases involved the right coronary artery (RCA). A case where transient right coronary spasm provoked right ventricular ischemia and collapse is described.     

Comparison of deferral rates using a computerized versus written blood donor questionnaire: a randomized, cross-over study [ISRCTN84429599]

Background  

Self-administered computer-assisted blood donor screening strategies may elicit more accurate responses and improve the screening process.