印度成人对于儿童眼保健的认识及贫困因素对其的影响

目的：探讨印度金奈地区成人对于儿童视力筛查的认识以及贫困因素对其的影响。
　　方法：此研究采用为期4wk的现况研究方法,于2012－12在印度金奈市及周边社会经济发展水平较低的地区,随机选取参加拓展营的个体作为研究对象。在接受了免费的视力筛查之后,与他们进行了一个简短的半结构性面谈。每隔两位选取一位受访者在一开始就被问及是否有儿童居住在他们住宅区,回答肯定者则纳入此项研究。
　　结果：本研究共纳入120人,其中38％（95％CI：30～47）的人指出在他们住宅区内至少有一名儿童先前接受过眼部检查（组1）,62％（95％CI：53～70）的参与者表示无儿童曾经接受过眼科检查（组2）。采用简单贫困记分卡方法测量两组贫困比分并无统计学差异。
　　结论：据不到半数的参与者回忆,他们的孩子之前曾接受过眼部检查。在贫困比分上,确认之前曾接受过眼部检查的参与者与没有接受过眼科检查的参与者之间无统计学差异。与孩子从未接受过眼科检查的参与者相比,那些孩子接受过眼部检查的参与者对该检查抱有更积极的态度。研究表明,成人对于孩子接受眼部检查重要性的认识不受贫困程度的影响,提高成人对于儿童接受眼部检查的认识可能需要更多的干预措施而不是扶贫。     

Anti-IgE in allergic asthma and rhinitis: an update

Allergic asthma and rhinitis imposes a huge burden in terms of treatment costs, productivity loss and hospital admissions. IgE plays a significant role in the manifestation of these conditions and the identification of a monoclonal antibody that binds to IgE provides clinicians another therapeutic strategy in the management of these conditions. Blocking the effects of IgE by omalizumab, a recombinant humanized monoclonal antibody that selectively binds to IgE has been shown to be a useful adjunct in the treatment of allergic asthma and rhinitis. Omalizumab is effective as a steroid reducing agent in patients with severe asthma and is successful in decreasing asthma exacerbations. Omalizumab was well tolerated in clinical trials, however, the potential long-term side effects need careful monitoring. The high cost of the molecule could make this a therapeutic option in a small proportion of patients in whom there is a large unmet need.     

Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint

Introduction The collateral ligaments of the first metacarpophalangeal (MCP) joint provide stability to the thumb. Injury to these collateral ligaments occurs more commonly in sports accidents leading to joint instability, weakness in pinch and grip strength. Normal morphometric measurements of collateral ligaments are essential for primary repair or reconstruction of the injured ligament. Hence, the objective of the study is to give the detailed morphometric profile of the proper collateral ligaments of the MCP joint of the thumb. Materials and Methods A total of 55 adult cadaveric hands were included in the study taken from 18 male (36 hands) and 10 female (19 hands) cadavers. Out of 55 hands, 28 belonged to the left side, while 27 were of the left side. The MCP joints were dissected to expose the collateral ligament complex. The length and width of the proper ligaments were measured. Results Both the proper collateral ligament attachments and the direction of the fibers were defined. Overall length and the width of both the proper collateral ligaments showed no statistically significant difference of mean between the left and the right sides. However, the length of both the proper collateral ligaments is significantly less in females compared with the males. Conclusion The morphometric details of the proper collateral ligaments obtained from this study would be useful for hand surgeons during surgical correction of the injured collateral ligaments either by primary repair or reconstruction with a tendon graft.     

State Policy Environment and Delayed or Forgone Care Among Children with Special Health Care Needs

Objective To evaluate if children with special health care needs (CSHCN) residing in states with more generous public insurance programs were less likely to report delayed or forgone care. Methods We used multilevel modeling to evaluate state policy characteristics after controlling for individual characteristics. We used the 2001 National Survey of CSHCN for individual-level data (N = 33,317) merged with state-level data, which included measures of the state’s public insurance programs (Medicaid eligibility and enrollment, spending on Medicaid, SCHIP and Title V, and income eligibility levels), state poverty level and provider supply (including pediatric primary care and specialty providers). We also included a variable for state waivers for CSHCN requiring institutional level care. Results Delayed or forgone care significantly varied among CSHCN between states, net of individual characteristics. Of all the state characteristics studied, only the Medicaid income eligibility levels influenced the risk of experiencing delayed care. CSHCN living in states with higher income eligibility thresholds or more generous eligibility levels were less likely to experience delayed care (OR 0.89(0.80,0.99); P ≤ 0.05). Conclusions By analyzing child health policy in the context of individual characteristics that may place a child at risk for delayed care, we determined that improving Medicaid eligibility levels improved the process of care for CSHCN.     

The staged island flap: a new method of repair for thumb injuries

An island flap from the middle finger is described which can be used to cover a terminal wound on the thumb and the adjacent palmar and dorsal defects of the thumb. The flap is transferred in two stages: the first stage ensures good skin cover using a simple technique and the second stage is nerve repair, giving good sensory return with correct cortical representation. Since 1977, 64 repairs have been carried out using this island flap. The follow-up, results and complications are discussed.