Toys in the upper aerodigestive tract: new evidence on their risk as emerging from the Susy Safe Study

Foreign body (FB) inhalation, aspiration or ingestion are relatively common events in children. Despite many efforts made in several countries to achieve acceptable safety levels for consumer products devoted to children, small toys or toy parts are still frequently mentioned among risky foreign bodies. The aim of the present study is to characterize the risk of complications and prolonged hospitalization due to toys inhalation, aspiration or ingestion according to age and gender of patients, FB characteristics, circumstances of the accident, as emerging from the Susy Safe Registry. The Susy Safe Registry started in the 2005 to collect data to serve as a basis for a knowledge-based consumer protection activity. It is actually one of the wider databases collecting foreign body injuries in the upper aero-digestive tract in pediatric patients. It is distinguished by a deep characterization of objects which caused the injuries and a multi-step quality control procedure which assures its reliability. Preventive strategies imposing a regulation of industrial production, even if fundamental, are not sufficient and need to be integrated along with other intervention addressed to make aware caregivers toward a proper surveillance of children.     

The Intersection of Medical Debt and Predatory Lending Among Hispanics

This pilot study explored the link between predatory lending and health care debt among Hispanics. Research shows that links exist between health care costs, debt, poverty, and race (Draught & Silva, 2003 Draught, T., & Silva, J. (2003). Borrowing to make ends meet: The growth of credit card debt in the 90's. Dēmos. http://archive.demos.org/pubs/borrowing_to_make_ends_meet.pdf (http://archive.demos.org/pubs/borrowing_to_make_ends_meet.pdf)  [Google Scholar]; Zeldin & Rukavina, 2007 Zeldin, C., & Rukavina, M. (2007). Borrowing to stay healthy: How credit card debt is related to medical expenses. Demos & the Access Project. http://www.demos.org/pubs/healthy_web.pdf (http://www.demos.org/pubs/healthy_web.pdf)  [Google Scholar]). Prior to this study there was no research on the intersection between medical debt and predatory lending although there was reason to believe this link exists (Seifert, 2004 Seifert, R.W. 2004. The demand side of financial exploitation: The case of medical debt. Housing Policy Debate, 15(3): 785–803.  [Google Scholar]). Our results confirm this link and we propose means to break it.     

Isolating the impact of antipsychotic medication on metabolic health: Secondary analysis of a randomized controlled trial of antipsychotic medication versus placebo in antipsychotic medication naïve first-episode psychosis (the STAGES study)

Background

Cardiovascular and metabolic diseases are the leading contributors to the early mortality associated with psychotic disorders. To date, it has not been possible to disentangle the effect of medication and non-medication factors on the physical health of people with a first episode of psychosis (FEP). This study aimed to isolate the effects of antipsychotic medication on anthropometric measurements, fasting glucose and lipids.

Methods

This study utilized data from a triple-blind randomized placebo-controlled trial comparing two groups of antipsychotic-naïve young people with a FEP who were randomized to receive a second-generation antipsychotic medication (FEP-medication group) or placebo (FEP-placebo group) for 6 months. Twenty-seven control participants were also recruited.

Results

Eighty-one participants commenced the trial; 69.1% completed at least 3 months of the intervention and 33.3% completed the full 6 months. The FEP-placebo group gained a mean of 2.4 kg (±4.9) compared to 1.1 kg (±4.9) in the control participants (t = 0.76, p = .45). After controlling for multiple analyses, there was no difference in blood pressure, waist circumference or heart rate between the FEP-placebo group and controls. After 6 months, the FEP medication group had gained 4.1 kg (±4.5), higher than those receiving placebo but not statistically significant (t = 0.8, p = .44). There were no differences in fasting glucose or lipids between the FEP groups after 3 months.

Conclusions

While limited by small numbers and high attrition, these findings indicate that some of the metabolic complications observed in psychotic disorders could be attributable to factors other than medication. This emphasizes the need to deliver physical health interventions early in the course of FEP.     

Mechanical and physical properties of silorane and methacrylate-based composites

ObjectivesThis study measured the degree of conversion (DC), sorption, solubility and microhardness of methacrylate (Filtek Z250 and Filtek Z350XT) and silorane-based composites (Filtek P90).MethodsDC was measured using near infrared spectroscopy immediately and 24 h after the photoactivation. Sorption and solubility measurements were performed after 24 h, 4 weeks and 12 weeks of storage in water. Knoop microhardness was measured after 24 h and after thermal cycling. The data were statistically analyzed using ANOVA followed by Tukey's, Tamhane or paired t-tests (α = 0.05).ResultsThe DC for P90 (37.22 ± 1.46) was significantly lower than the Z250 (71.44 ± 1.66) and Z350 (71.76 ± 2.84). Water sorption was highest in the Z250 and lowest in the P90. All the tested composites exhibited similar values after 24 h of immersion, and no significant differences were observed. No significant differences were observed between the solubilities of the P90 composite (12 weeks) and the Z250 or Z350 composites (4 weeks). KHN values were less elevated for the P90 composite and similar for the Z250 and Z350 composites. An effect of thermal cycling on KHN values was observed for all the composites (p < 0.001).ConclusionsSilorane produced the lowest DC and KHN values and exhibited lower water sorption and solubility compared to methacrylate-based composites. These differences suggest that silorane composites exhibit better hydrolytic stability after 3 months of water immersion compared to conventional methacrylate-based composites.Clinical significanceSilorane had higher hydrolytic stability after 3 months of water immersion than the methacrylate-based resins, despite the lower values of DC and KHN recorded.     

A family outbreak of hemolytic-uremic syndrome associated with verotoxin-producingEscherichia coli serotype 0157:H7

All five siblings (three boys and two girls, aged 1.5–9 years) in a family developed hemolytic-uremic syndrome associated with verotoxin-producingEscherichia coli 0157:H7 at a lakeside vacation cottage during the fall of 1985. All five were hospitalized and made a full recovery. Both parents remained asymptomatic, and neither had evidence of this infection. In four children who were investigated prospectively, free verotoxin was still detectable in the stools for between 3 and 7 weeks. The prodromal diarrheal illness in the children occurred over a 10-day period. The epidemic curve was consistent with a point-source outbreak, but continuous exposure or person-toperson transmission could not be ruled out. The source of the infection was not identified.Material from this paper has been presented previously in abstract form: GS Arbus, MA Karmali, N Ish-Shalom (1986). A family outbreak of hemolytic-uremic syndrome affecting 5 siblings associated with Verotoxin-producingEscherichia coli 0157:H7, presented at the 7th International Congress of Pediatric Nephrology, Tokyo     

Low awareness but positive attitudes toward fecal transplantation in Ontario physicians

BACKGROUND:

Despite mounting evidence supporting fecal transplantation (FT) as a treatment for recurrent Clostridium difficile infection (CDI), adoption into clinical practice has been slow.

OBJECTIVE:

To determine the health literacy and attitudes of academic physicians in Toronto and infectious disease physicians in Ontario toward FT as a treatment for recurrent CDI, and to determine whether these are significant barriers to adoption.

METHODS:

Surveys were distributed to 253 general internists, infectious diseases specialists, gastroenterologists and family physicians.

RESULTS:

The response rate was 15%. More than 60% of physicians described themselves as being ‘not at all’ or ‘somewhat’ familiar with FT. Of the 76% of physicians who had never referred a patient for FT, the most common reason (50%) was lack of awareness of where to access the treatment. The ‘ick factor’ accounted for only 13% of reasons for not referring. No respondent believed that the procedure was too risky to consider.

CONCLUSION:

Despite general poor health literacy on FT, most physicians sampled share similar positive attitudes toward the treatment.     

“Interactive surfaces” technology as a potential tool to stimulate physical activity in psychogeriatric nursing home residents

Purpose: The aims of this study were to determine whether and how psychogeriatric nursing home residents would respond to the interactive surfaces on the floor without receiving instructions and to determine how long residents would be physically active. Methods: The “interactive surfaces” technology includes different graphic shapes that are projected through a beamer on a floor. The surfaces are “activated” by a person’s movements in the area of the projection field, which is detected by an infrared camera. Every day for 1?h during an 11-day period one of seven different projections was shown. Spontaneous observed physical responses were counted, clustered and visualized in a tree diagram. Duration of physically responses was measured per session and during the total observation period of 11?h. Results: During 343 of 490 observations residents (n?=?58) noticed the interactive surface and in 148 observations they engaged physically. In total, 4067?s (1?h, 7?min and 47?s) of physical activity were measured. Individual times that residents were active ranged from 3 to 415?s. Conclusions: Interactive surfaces technology may be a promising tool in psychogeriatric nursing home residents to stimulate physical activity. Further research is needed to assess its full potential.

• Implications for Rehabilitation

• Innovative technology used to adapt the environment might stimulate nursing home residents to become more physically active.

• The use of innovative technologies may increase physical activity without necessarily increasing the workload of care professionals.