Evaluating health promotion in schools: a case study of design, implementation and results from the Hong Kong Healthy Schools Award Scheme

Health promoting schools (HPS) and Healthy Schools Award Schemes from a number of countries have demonstrated positive changes in children's health behaviours and the culture and organisation of the school. The Hong Kong Healthy Schools Award Scheme (HKHSA) aims to promote staff development, parental education, involvement of the whole school community, and linkage with different stakeholders to improve the health and well-being of the pupils, parents and staff, and the broader community, supported by a system to monitor the achievement. This concept is very much in line with the research literature on school effectiveness and improvement. The indicators examined to evaluate the success of the HKHSA reflect outcomes related to both health and education and are not limited to changes in population health status. The early results demonstrated significant improvements in various aspects of student health and also improvement in school culture and organisation. The evaluation framework described in this paper and data collected to assess how schools perform in the HKHSA scheme, provides insight into how HPSs could lead to better outcomes for both education and health.     

Plasma fatty acid composition is associated with the metabolic syndrome and low-grade inflammation in overweight adolescents

BACKGROUND: Together with adiposity, plasma fatty acid (FA) composition can modulate the development of the metabolic syndrome (MS). OBJECTIVE: Our aim was to investigate the relations of FA composition in plasma phospholipids and cholesterol esters (CEs) with weight status, MS, and inflammation in adolescents. DESIGN: Plasma FA composition was measured by gas-liquid chromatography in 120 (60 normal-weight and 60 overweight) 12-y-old adolescents. We also measured the presence of MS, insulin resistance with the homeostasis model assessment, and interleukin 6 and C-reactive protein concentrations in the adolescents. RESULTS: MS was present in 25% of the overweight adolescents but in none of the normal-weight adolescents. Compared with overweight adolescents, normal-weight adolescents had lower saturated FAs (SFAs) in both phospholipids (P < 0.001) and CEs (P < 0.01) and higher docosahexaenoic acid in phospholipids (P < 0.001). In overweight subjects, FA composition was associated with MS features independent of body fat. The odds ratios of MS for a 0.1 increase in the ratio of polyunsaturated FAs (PUFA) to SFAs (PUFA:SFA) were 0.91 in phospholipids (P = 0.03) and 0.90 in CEs (P = 0.06). In phospholipids, PUFA:SFA and linoleic acid were associated positively with HDL cholesterol (P < 0.01 for both). PUFA:SFA in phospholipids and CEs were associated inversely with interleukin 6 (P < 0.05 for both). Eicosapentaenoic acid in phospholipids (P = 0.06) and CEs (P < 0.05) and linolenic acid in CEs (P < 0.05) were inversely related to C-reactive protein. These relations remained significant after adjustment for the waist-to-hip ratio. No significant relation between FA composition and the homeostasis model assessment was observed. CONCLUSIONS: Plasma FA composition is associated with weight status in healthy adolescents. High intake of long-chain PUFAs, especially n-3 PUFAs, may protect obese subjects against MS and low-grade inflammation as early as adolescence.     

Socioeconomic impact of insomnia in working populations

To determine whether insomnia impact the professional life of patients and have an economical weight, this review article focused on the socioeconomic impacts of sleep related problems in working populations. The goal is to summarise the work that has been accomplished in that field. Several occupational factors have an impact on insomnia: the work schedules (shift work and night work), the physical environment at work and the occupational stressors. Insomnia is also a common problem in daytime workers. The daytime functioning of insomniacs is a key point to understand the impact of insomnia on workers. Absenteeism is one major target in the evaluation of severe insomnia at the workplace. Most of the studies find a higher rate of work accidents in insomniacs. The economic impact is severe in term of direct and indirect costs. Insomnia is a common problem at the workplace. The negative impact is not only on individual but also at the societal levels. More epidemiological studies appear warranted to demonstrate a reciprocal link between work conditions and sleep disorders.     

Zur Probevertebrotomie

Zusammenfassung Wenn sich die Natur eines Krankheitsprozesses an einem Wirbelkörper durch klinische, röntgenologische und Laboruntersuchungen nicht abklären läßt, sollte die Diagnose durch eine Probevertebrotomie gesichert werden, sofern der Eingriff dem Patienten zuzumuten und von der Klärung der Diagnose therapeutische Konsequenzen zu erwarten sind. Der Wert des Probeschnittes wird durch die Beschreibung eines isolierten durch Operation geklärten Plasmocytoms des 10. Brustwirbels erhärtet.Mit 1 TextabbildungNach einem Vortrag auf der Tagung der Nordwestdeutschen Orthopäden-Vereinigung in Bonn, Mai 1963.     

Zollinger-Ellison syndrome and parathyroid adenoma. Limits of Wermer's syndrome]

The authors report the case of a patient with pancreatic and parathyroid adenomatosis and discuss whether it belongs to Wermer's syndrome. After a study of the various possible endocrine involvements, the complexity of hormonal inter-relations is studied, the prognosis and classification of multiple endocrine tumours are then discussed.     

A case of stunning of lung and bone metastases of papillary thyroid cancer after a therapeutic dose (3.7 GBq) of 131I and review of the literature: implications for sequential treatments

Thyroid stunning is usually defined as the inhibition or suppression of iodide trapping by remnant thyroid tissue or by functioning metastases following a diagnostic dose of 131I. The risk of stunning increases progressively with larger doses. Because the threshold above which this effect occurs in thyroid remnants seems to be between 37 MBq and 111 MBq of 131I, therapeutic 131I doses of 3.7 GBq may cause stunning. We describe stunning of papillary thyroid cancer lung and bone metastases after a therapeutic dose of 131I (3.7 GBq). A T1 bone metastasis and bilateral lung metastases were diagnosed by post-therapeutic dose whole-body scan. Nuclear MRI detected another lesion at T4, whose 131I fixation was not obvious. An additional 0.7 GBq were given after recombinant TSH, 37 days after the therapeutic dose; 24 h later, uptake by the lung and T1 metastases had disappeared, but trapping was again seen 6 months later on the post-therapeutic scan. This re-appearance is evidence in favour of the transitory and reversible character of stunning, and confirms its correspondence to the decreased ability of viable thyroid cells to trap iodine and not to their destruction. A better understanding of stunning would make it possible, in the event of rapidly progressing disease and in conjunction with recombinant thyroid stimulating hormone (TSH), to give several therapeutic doses of 131I in close succession without each dose hampering the effectiveness of the subsequent one.     

Acute severe spinal cord dysfunction in a child with meningitis: Streptococcus pneumoniae and Mycoplasma pneumoniae co-infection

Tetraplegia developed abruptly in an 11-y-old with pneumococcal meningitis. Magnetic resonance imaging showed multiple hyperintensities at the brainstem–spinal cord junction. Serological tests were positive for Mycoplasma pneumoniae (microparticle agglutination and specific IgMs). Erythromycin and dexamethasone were started promptly, and 10 d later the patient was discharged with normal neurological function.
Conclusion: Tetraplegia during the course of pneumococcal meningitis in an 11-y-old girl disappeared after treatment with ceftriaxone, erythromycin and dexamethasone.     

Cesarean delivery after successful external cephalic version of breech presentation at term: a comparative study

OBJECTIVE: The purpose of this study was to evaluate the rate and indications of cesarean delivery after a successful external cephalic version. STUDY DESIGN: A case-control study was performed from patients who were delivered in a tertiary care center between 1987 and 2000. Each patient who underwent a successful external cephalic version (study group) was compared with the next woman with the same parity, who was delivered at term (control group). Nulliparous and multiparous women were analyzed separately. Chi-squared, Mann-Whitney, and Student t tests were used for statistical analysis. Multivariate logistic regression analysis was performed where appropriate. RESULTS: A total of 602 patients were included in this study. The rates of cesarean delivery in nulliparous women (29.8% vs 15.9%; P<.001) and in multiparous women (15.9% vs 4.7%; P<.001) were significantly higher when compared with the control group. Patients with successful external cephalic version were more likely to have a cesarean delivery for dystocia (nulliparous, 22.5% vs 11.9%; P=.01; multiparous, 10.9% vs 1.3%; P<.01). After an adjustment for confounding variables, a successful external cephalic version was associated with an increased rate of cesarean delivery at term (nulliparous: odds ratio, 2.04; 95% CI, 1.13-3.68; multiparous: odds ratio, 4.30; 95% CI, 1.76-10.54). CONCLUSION: The rate of cesarean delivery for dystocia is increased after a successful trial of external cephalic version in both nulliparous and multiparous women.