SMOKELESS TOBACCO USE AMONG ADULTS IN THE NORTHERN PROVINCE OF SOUTH AFRICA: QUALITATIVE DATA FROM FOCUS GROUPS

The aim of this study was to investigate perceptions on the use of smokeless tobacco in the Northern Province, South Africa. Ten focus groups were conducted in 1999 with two heterogeneous groups (5 with middle-aged and 5 with the aged). They were mainly Northern Sotho speaking. From 72 participants 16 women and 8 men admitted to using snuff. The most popular types of smokeless tobacco used were homemade snuff and only a few used ‘commercial” snuff. The basic ingredients for homemade snuff were tobacco and other plant leaves. Snuff was found to have important functions and to be socially acceptable in the groups studied mainly for ceremonial and medicinal use and to a lesser degree for relaxation and pleasure. Generally, positive and medicinal effects were noted for snuff use. Most participants agreed that it is addictive, but only a few acknowledged the negative effects in terms of causing cancer.     

Outcomes of Carotid Revascularization in Patients with Contralateral Carotid Artery Occlusion

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抗感染治疗和抗菌药物管理-ASHP 2019年中会议综述

 美国卫生系统药师协会年中会议（ASHP Midyear）作为全球规模最大的药师会议之一，以发布国际前沿的临床用药研究闻名，针对医院药学领域的热点、难点提出创新和科学建议。在2019年12月召开的最近一次ASHP Midyear上，抗菌治疗和抗菌药物管理依然是关注重点，同时针对菌血症、耐甲氧西林金黄色葡萄球菌、艰难梭菌、青霉素过敏、医疗机构抗菌药物管理项目（ASP）等均发布了颇有意义的内容，以上内容同时也是国内医院抗感染领域关注的热点问题。本文就参会的启示和感想作一分享，并对笔者所在医院开展的ASP项目作一介绍。     

Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures

BackgroundOpen pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality.MethodsA query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher’s exact test and chi-square test for categorical variables, and Welch’s t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications.ResultsA total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality.ConclusionWe report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population.Level of EvidenceLevel II, Retrospective study.     

Cultural–Ecological Theory of Academic Disengagement Used to Explain a Story of Race,Culture and Education

Students of African ancestry often share an experience of being a racialized minority in the context of the educational institution. Late Professor of Anthropology John Ogbu’s Cultural-ecological Theory of Academic Disengagement is employed to describe the negative responses encountered by peers in the name of academic achievement.The late Nigerian-American anthropologist John Ogbu described that it is often socially disadvantageous for black youth to prosper academically in formal education. Black students are often seen as betraying their cultural identities by aspiring to academic success and scholastic achievement and are met with repugnance by black peers.The notion of “acting white” is unnecessary, impertinent should be abandoned outright as achievement should have no color.     

Helping Clients Feel Welcome: Principles of Adapting Treatment Cross-Culturally

ABSTRACT

Empirically supported interventions (ESIs) for treating substance problems have seldom been made available to or tested with minority populations. Dissemination of ESIs may help reduce the disproportionate health disparities that exist. However, ESIs may require some adaptation to be effective with minority populations. One ESI, motivational interviewing (MI), appears to be particularly culturally congruent for Native American communities. We worked with Native American community members and treatment providers to adapt MI for Native communities. Reflecting their feedback and suggested amendments, we created and disseminated an intervention manual to improve the accessibility of MI within Native communities. To help guide practitioners working with Native American clients, we used focus-group methodology to explore communication patterns for negotiating change. Native American treatment providers expressed comfort with and enthusiasm for integrating MI into their current practices. Recommendations for adaptations ranged from simple to complex changes. The unique value and challenges of collaboration between academic and community members are presented from each author's perspective. This culturally adapted MI manual will likely improve the accessibility and adoption of MI practices as well as encourage controlled, clinical trials with Native communities.