Equity, empowerment and choice: from theory to practice in public health

The purpose of this article is to illustrate how a framework that links equity and empowerment to improved health outcomes for those who live in poverty can be a useful tool for planning and managing health programmes. Using the work of Amartya Sen, Susan Rifkin has developed a framework described in the acronym CHOICE. The article applies the framework to two case studies from Kenya seeking to reduce the disease burdens of malaria and HIV/AIDS. The article examines how the process of pursuing equity and empowerment either supports the positive health outcomes identified as objectives and/or strengthens these outcomes.     

A Nepalese bipolar case amidst risk and protective factors during COVID‐19 pandemic

Bipolar disorder is a chronic and recurring psychiatric illness. Emphasis on enhancing key protective factors like social support systems and promoting this to minimize risk factors like non‐compliance is one of the key strategies tied to enhance overall psychological, intellectual, and emotional health for symptoms remission and relapse prevention even during adverse situations like the COVID‐19 crisis. We intend here to point out implication of the dynamics of the protective and risk factors for bipolar mood through a 23‐year patient from eastern Nepal, which is largely harmonious in its multi‐ethnic, multilingual and multicultural social composition. This attribute of social cohesiveness and compassion is evident in this case report. When disturbed and ill, neighbors from native semi‐urban Nepalese society did support even in the times of crisis of COVID‐19 pandemic. The support of other people including neighbors is a key factor for the short‐term and long‐term management of bipolar mood.     

Prolonged intraperitoneal dwell decreases ultrafiltration coefficient in rabbits

In rabbits undergoing peritoneal dialysis, hypertonic (6% dextrose) dialysis solution increased the net ultrafiltration rate (UF) from 233 to 462 microL/kg/min, which was not proportional to the increment in the osmotic gradient, so the ultrafiltration coefficient decreased. As intraperitoneal dwell of hypertonic dialysate was prolonged, the gross and net UFs and ultrafiltration coefficients decreased, and the UF per dextrose absorption declined. The decrement in UF was multifactorial, including a component of fluid and solute stagnation, increasing the distance over which osmotic forces must exert their effects. Excessively hypertonic dialysis fluid should be used only briefly to achieve ultrafiltration efficiently and to avoid the high dextrose loading.     

Cherubism

Cherubism, a rare tumour like lesion, is characterised by bilateral, painless, firm jaw swellings with cherubic appearance of face. It affects children of both sexes and is often familial. A case of Cherubism is being reported here because of its rarity and first from this geographical area.     

Cherubism

Cherubism, a rare tumour like lesion, is characterised by bilateral, painless, firm jaw swellings with cherubic appearance of face. It affects children of both sexes and is often familial. A case of Cherubism is being reported here because of its rarity and first from this geographical area.     

Vocal cord dysfunction presenting as refractory asthma

Vocal cord dysfunction is a rare variety of upper airway obstruction characterized by typical laryngoscopic features and may mimic an acute asthma attack. The case presented in this report pertains to a 15-year-old girl who had repeated acute episodes of dyspnoea and wheezing and remained non-responsive to corticosteroids and inhaled bronchodilators requiring endotracheal intubations for adequate control. Laryngoscopic findings were consistent with vocal cord dysfunction. She was treated with a tracheostomy and psychological support.     

Time to ambulation after hip fracture surgery: relation to hospitalization outcomes

OBJECTIVE: To test the hypothesis: Time to ambulation (walking) after hip fracture surgery impacts the frequency of postoperative complications and length of hospital stay. METHODS: A retrospective observational study of a cohort of all patients admitted to a university teaching hospital with a principal International Classification of Diseases-9 diagnosis of a hip fracture during 3 calendar years. RESULTS: A total of 131 participants were identified (68% were aged 65 years or older). Overall, the mean time to writing an order to ambulate a patient after a hip fracture surgery was 2 +/- 1.5 days. Time to ambulation after hip fracture surgery was significantly less in patients cared for on orthopedic surgery service compared to general surgery service (1.8 +/- 1 vs 2.5 +/- 2, p <.05) or general internal medicine service (2.5 +/- 1.5, p <.05). It did not relate, however, to patient's age, sex, or race, or to patient's functional status prior to admission, fracture site (femoral neck, intertrochanteric, or subtrochanteric), whether a femoral neck fracture is displaced or not, type of anesthesia (spinal/epidural vs general), type of surgery (open reduction and internal fixation vs hemiarthroplasty), degree of preoperative risk, number of medical conditions, or to obtaining physical therapy and/or medical consultation. Time to ambulation after surgery was an independent predictor for the development of pneumonia (1.5 OR [odds ratio]/day, p <.001), new onset delirium (1.7 OR/day, p <.001), and to prolonged length of hospital stay (B [slope coefficient] = 1.36, p <.0001) but not to the development of pressure ulcers, deep venous thrombosis, or urinary tract infection. CONCLUSIONS: Delayed ambulation after hip fracture surgery is related to the development of new onset delirium and pneumonia postoperatively as well as to increased length of hospital stay. Early ambulation after hip fracture surgery should be encouraged.     

Zinc supplementation as adjunct therapy in children with measles accompanied by pneumonia: a double-blind,randomized controlled trial

BACKGROUND: Zinc deficiency, common in developing countries, is associated with decreased immunocompetence. Zinc supplementation benefits children with acute and persistent diarrhea and prevents pneumonia. Most deaths from vaccine-preventable diseases are from measles and whooping cough; pneumonia is the most common complication of measles and often the proximate cause of related deaths. OBJECTIVE: We evaluated the effect of zinc supplementation on episodes of illness in children with measles accompanied by pneumonia. DESIGN: In a double-blind, randomized controlled trial, children aged 9 mo-15 y who were admitted to the Infectious Diseases Hospital in Calcutta with clinically severe measles accompanied by pneumonia and who had been ill for 相似文献