Poverty: a major deterrent to America's good health

Poverty has a major impact on the nation's state of health. Although its effects are difficult to separate from that of old age and the problems of minorities, there are definite correlations between indicators of economic well being and mortality/morbidity rates United States vital statistics and extensive health interview surveys provide ample documentation of the role of poverty as a health determinant. The success the Indian Health Service has had in lowering mortality rates mirrors the nation's as a whole and demonstrates what can be done if socioeconomic conditions, as well as health care delivery, is improved. The message should not be lost sight of it this era of cutbacks in social programs.     

Performance of the national nosocomial infections surveillance risk index in predicting surgical site infection in australia.

BACKGROUND: The Victorian Hospital Acquired Infection Surveillance System (VICNISS) hospital-acquired infection surveillance system was established in 2002 in Victoria, Australia, and collates surgical site infection (SSI) surveillance data from public hospitals in Australia. OBJECTIVE: To evaluate the association between the US National Nosocomial Infections Surveillance (NNIS) system's risk index and SSI rates for 7 surgical procedures. METHODS: SSI surveillance was performed with NNIS definitions and methods for surgical procedures performed between November 2002 and September 2004. Correlations were assessed using the Goodman-Kruskal gamma statistic. RESULTS: Data were submitted for the following numbers of procedures: appendectomy, 545; coronary artery bypass graft (CABG), 4,632; cholecystectomy, 1,001; colon surgery, 623; cesarean section, 4,857; hip arthroplasty, 3,825; and knee arthroplasty, 2,416. NNIS risk index and increasing SSI rate were moderately well correlated for appendectomy ( gamma =0.55), colon surgery ( gamma =0.48), and cesarean section ( gamma =0.42). A fairly positive correlation was found for cholecystectomy ( gamma =0.17), hip arthroplasty ( gamma =0.2), and knee arthroplasty ( gamma =0.16). However, for CABG surgery, a poor association was found ( gamma =0.02). CONCLUSIONS: The NNIS risk index was positively correlated with an increasing SSI rate for all 7 procedures; the strongest correlation was found for appendectomy, cesarean section, and colon surgery, and the poorest correlation was found for CABG surgery. We believe that risk stratification with the NNIS risk index is appropriate for comparison of data for most procedures and superior to use of no risk adjustment. However, for some procedures, particularly CABG, further studies of alternative risk indexes are needed to better stratify patients.     

Penetrating eye injury from a rigid infant pacifier

Background: The use of infant pacifiers (dummies) is common in Australasian communities and has been reported to be associated with various injuries, but to date ocular trauma has not been reported.
Case report: A 14-month-old child sustained a penetrating eye injury from the infant pacifier that was in his mouth during a minor fall. Only a lid laceration was detected at the time. One week later he presented with mydriasis, heterochromia and a poor red reflex. Diagnosis of a penetrating eye injury was made by examination under anaesthesia, with B-scan ultrasonography demonstrating hypotony but no retinal detachment or intraocular foreign body. Funduscopy revealed a small inferior vitreous haemorrhage. Exploration of the globe adjacent to the lid wound showed a 6 mm laceration through the sclera plugged with prolapsed vitreous.
Conclusion: Serious ocular injury may result after a minor fall with some designs of rigid infant pacifiers. Heterochromia and anisocoria noted by the mother heralded more serious ocular injury in this case. The delay in diagnosis of this injury emphasises the importance of ocular examination to exclude eye trauma when injuries occur around the orbit.     

Eccentric ruthenium plaque radiotherapy of posterior choroidal melanoma

Background

The aim of this work is to report on conservation of visual acuity after eccentric ruthenium¹⁰⁶ (Ru-106) brachytherapy of posterior choroidal melanoma.

Methods

Fifty-four patients with choroidal melanoma extending to within 5?mm of the optic disc or fovea were treated at a single institution during the 3?years up to July 31, 2007. The plaque was positioned eccentrically with its posterior edge aligned with the posterior tumor margin to reduce the radiation dose to the optic disc and fovea. The main outcome measures were local tumor control and conservation of vision of 6/12 or better, according to baseline variables.

Results

The tumors had a mean longest basal diameter of 12.0?mm and a mean thickness of 3.1?mm. The posterior tumor margin extended to within 3?mm of the fovea in 30 patients (56%). In the 24 eyes with the posterior tumor margin located 3.1–5.0?mm from the fovea, 74.9% retained visual acuity of 6/12 or better 4?years after treatment (95% confidence interval [CI], 55.5–94.3%). In the 30 eyes with tumor extension to within 3.0?mm of the fovea, then 3?years after treatment only 25.3% retained such vision (95% CI, 5.3–45.3%). Recurrence at the posterior tumor margin occurred in two patients.

Conclusions

Eccentric ruthenium¹⁰⁶ plaque radiotherapy of posterior choroidal melanoma achieves good rates of local tumor control and conservation of vision if special measures are taken to ensure that the plaque is positioned correctly.     

Typhoid fever in the neapolitan area: A case-control study

Typhoid fever is endemic in the Neapolitan area, where its yearly incidence rate largely exceeds the corresponding national figure. During the period from January to June, 1990, a matched case-control study was carried out in order to identify risk factors of the disease in this area; 51 subjects (mean age 27.2 years) with typhoid fever were compared with 102 controls matched with respect to age, sex and educational level. Consumption of raw shellfish was reported by 76.5% of the cases, as opposed to 19.6% of the controls (P < 0.01). Subjects who had eaten this food item had a 13.3-fold risk (C.I. 95% = 5.5 - 32.8) of contracting typhoid fever. In contrast, no risk was found to be associated with consumption of cooked shellfish, raw vegetables, ice-cream, non-potable water, or unpasteurized milk.The risk factor identified in this study shows that hazardous dietary habits and inadequate sewage treatment facilities, combined with lack of sanitation in the harvesting and marketing of shellfish, play a major role in the endemicity of typhoid fever in the Neapolitan area.Corresponding author.     

Estimating the chance of an inadequately immunised child getting pertussis

Before informed advice can be given to parents and health care workers about the need for pertussis immunisation, an estimate of the risk of inadequately immunised children contracting pertussis is needed. The study reported here was conducted because the literature contains no such estimates of risk. Analysis was made of a county's Notification of Disease Reports. Computation was carried out of age-specific annual notification rates of pertussis amongst adequately and inadequately immunised children. It was found that inadequately immunised one-year-old children probably have more than a one in six chance of developing pertussis before age ten.     

Causality in cancer research: a journey through models in molecular epidemiology and their philosophical interpretation

In the last decades, Systems Biology (including cancer research) has been driven by technology, statistical modelling and bioinformatics. In this paper we try to bring biological and philosophical thinking back. We thus aim at making different traditions of thought compatible: (a) causality in epidemiology and in philosophical theorizing—notably, the “sufficient-component-cause framework” and the “mark transmission” approach; (b) new acquisitions about disease pathogenesis, e.g. the “branched model” in cancer, and the role of biomarkers in this process; (c) the burgeoning of omics research, with a large number of “signals” and of associations that need to be interpreted. In the paper we summarize first the current views on carcinogenesis, and then explore the relevance of current philosophical interpretations of “cancer causes”. We try to offer a unifying framework to incorporate biomarkers and omic data into causal models, referring to a position called “evidential pluralism”. According to this view, causal reasoning is based on both “evidence of difference-making” (e.g. associations) and on “evidence of underlying biological mechanisms”. We conceptualize the way scientists detect and trace signals in terms of information transmission, which is a generalization of the mark transmission theory developed by philosopher Wesley Salmon. Our approach is capable of helping us conceptualize how heterogeneous factors such as micro and macro-biological and psycho-social—are causally linked. This is important not only to understand cancer etiology, but also to design public health policies that target the right causal factors at the macro-level.     

Predicting rehospitalization and outpatient services from administration and clinical databases

The study tests whether psychiatric services utilization may be predicted from administrative databases without clinical variables equally as well as from databases with clinical variables. Persons with a psychiatric hospitalization at an urban medical center were followed for 1 year postdischarge (N=1384.) Dependent variables included statewide rehospitalization and the number of hours of outpatient services received. Three linear and logistic regression models were developed and cross-validated: a basic model with limited administrative independent variables, an intermediate model with diagnostic and limited clinical indicators, and a full model containing additional clinical predictors. For rehospitalization, the clinical cross-validated model accounted for twice the variance accounted by the basic model (adjusted R²=.13 and .06, respectively). For outpatient hours, the basic cross-validated model performed as well as the clinical model (adjusted R²=.36 and .34, respectively.) Clinical indicators such as assessment of functioning and co-occurring substance use disorder should be considered for inclusion in predicting rehospitalization.