Malignant neoplasms of the nose and paranasal sinuses. A survey of cases treated in a regional centre

A review of 250 patients with malignant disease of the nose and paranasal sinuses treated over a 20 year period is presented. Treatment could be divided broadly into three groups consisting of subradical surgery plus radiotherapy; a drainage procedure plus radiotherapy and radiotherapy alone. Three and 5 year survival rates are presented for each mode of treatment for tumours originating in four anatomicalsites. In tumours of the maxillary antrum the 5 year survival was significantly higher in patients who underwent a partial maxillectomy or palatal fenestration before radiotherapy. In the other anatomical sites the survival rates were not significantly different. Although this is an uncontrolled retrospective review. it does add further data to that already published on this uncommon but difficult management problem.     

Enhancing students' perspectives of health through non-traditional community experiences

• ? The shift in emphasis to community-based health care necessitates that opportunities be provided for nursing students to acquire an understanding of the complex nature of health.
• ? A qualitative study was used to demonstrate the benefits accrued by junior baccalaureate nursing students in non-traditional community settings.
• ? Key themes that emerged from data analysis included definitions of health and illness as context specific, and environmental factors influencing health.
• ? The study demonstrated that learning experiences with diverse communities can broaden students' perspectives and understanding of health behaviours. Students gained an appreciation of the sociocultural variation in meanings of health and illness as well as of the social and political dimensions of health.

     

Alarmingly high prevalence of obesity in haemophilia in the state of Mississippi

Summary. The state of Mississippi has consistently been ranked as the state with most number of obese people in the United States with prevalence rates of >30%. Our aims in this study were to estimate the prevalence of overweight and obesity in children and adults diagnosed with haemophilia in Mississippi, and to assess whether race/ethnicity and the severity of haemophilia are important risk factors. A retrospective chart review was performed for all haemophilic patients seen at the Mississippi Hemophilia Treatment Center. Patients were classified into two major age groups: age 2–19.9 years and ≥20 years. Body mass index (BMI) was calculated from the height and weight in kg m^?2 from the last clinic visit. Out of a total of 132 haemophilic patients, 61% were white and 37% were African American. Overall, 51% of the haemophilic patients were either obese or overweight. The prevalence of obesity in the adult (≥20 years old) haemophilic patients was 36% and an additional 32% were overweight. A significantly greater proportion of patients >20 years old were overweight or obese as compared with the patients in the 2–19.9 year age range (P < 0.002). However, race/ethnicity and severity of haemophilia were not significant risk factors for overweight and obesity. There is a very high prevalence of obesity in the Mississippi haemophilic population, especially in adults. Particular attention at clinic visits should be paid to the BMI in order to identify patients that are overweight or obese to allow for early and appropriate intervention.