Lateral epicondylitis and physical exposure at work? A review of prospective studies and meta-analysis

International audience

Do hereditary syndrome-related gynecologic cancers have any specific features?

Hereditary syndromes are responsible for 10 % of gynaecologic cancers, among which hereditary breastovarian cancer and hereditary non-polyposis colon cancer syndromes, known as HBOC and Lynch syndromes respectively, present the highest relative risk. The latter predisposes to endometrial cancer and both contribute to ovarian cancer. Cowden syndrome-related endometrial cancer and the increased risk of ovarian, uterine and cervical cancers associated with Peutz-Jeghers syndrome, are also demonstrated, while Li-Fraumeni syndrome patients are prone to develop ovarian and endometrial cancers. Despite these syndromes’ susceptibility to gynaecologic cancers being consensual, it is still not clear whether these tumours have any epidemiologic, clinical, pathologic or imaging specific features that could allow any of the intervening physicians to raise suspicion of a hereditary syndrome in patients without known genetic risk. Moreover, controversy exists regarding both screening and surveillance schemes. Our literature review provides an updated perspective on the evidence-based specific features of tumours related to each of these syndromes as well as on the most accepted screening and surveillance guidelines. In addition, some illustrative cases are presented.

Efficacy of early skin-to-skin contact on the rate of exclusive breastfeeding in term neonates: a randomized controlled trial

Background: Despite multiple benefits of breast milk, the rates of exclusive breastfeeding in developing countries are low. Objective: To evaluate the efficacy of early skin -to -skin contact (SSC) on the rate of exclusive breastfeeding (EBF) at 6 weeks of age among term neonates born by vaginal delivery. Methods: Term neonates born by vaginal delivery and did not require any resuscitation were randomized at birth to SSC (n=100) and control (n=100) group. Immediately after clamping the umbilical cord, SSC group neonates were placed on the bare bosom of mother and control group neonates were placed under a radiant warmer for a period of 45 minutes each while mothers underwent management of the third stage of labor and episiotomy repair. Pain experienced by mother during episiotomy repair was recorded using a numerical pain scale The primary outcome evaluated was the rate of exclusive breastfeeding at 6 weeks of postnatal age. Results: A significantly higher proportion of neonates were exclusively breastfeed at 6 weeks of age in the SSC group than in the control group (72% vs. 57.6%, p=0.04, relative risk: 1.3, 95% confidence interval: 1.0 -1.6). The pain score during episiotomy repair in mothers of the SSC group was significantly lower than the control group (4.74±0.85 versus 5.34±0.81; P <0.01). Conclusions: Early SSC significantly improved the rate of exclusively breastfeeding at 6 weeks of age among healthy term neonates. An important additional effect was a decrease in the amount of pain that mothers in the SSC group experienced during episiotomy repair.

Impacto del programa educativo en el conocimiento del protocolo de atención prehospitalaria aplicado por socorristas en trauma. Machala 2011 – 2012

Los socorristas de traumatizados en el área pre-hospitalaria en la ciudad de Machala, carecen de profesionales con formación académica de tercer nivel, en su mayoría son bachilleres con cursos básicos de primeros auxilios Objetivo.- Determinar el impacto de un programa educativo en el nivel de conocimiento de los protocolos de atención en trauma, usados por los socorristas que laboran en atención pre-hospitalaria de la ciudad de Machala. Métodos.-Realizamos un estudio cuasi experimental con dos grupos: Grupo estudio (n: 46) y grupo control (n: 45). Muestra obtenida de forma no aleatoria por conveniencia. Los socorristas fueron evaluados al inicio del estudio por un test previamente establecido, al grupo de estudio se aplicó un programa educativo, al grupo control no se lo intervino. Dos meses después se evaluó el impacto del programa. Resultados.- El programa educativo mejora el conocimiento global un 43% en el grupo de estudio. El impacto del programa de la atención pre-hospitalaria demostró un incremento en conocimientos: en respiratorio 56%; 67.9% en circulatorio y el 19.2% en neurológico; pero disminuye: en vía aérea 10.9% y 7.6% en la exposición de la víctima. El Riesgo relativo luego de la intervención es de 4.45 y se necesita aplicar el programa educativo a dos personas para mejorar una (NNT -2.4). Conclusión.- El programa educativo es útil para mejorar el conocimiento sobre atención pre-hospitalaria en trauma, sin lograr en los participantes alcanzar el nivel esperado por lo heterogéneo de su formación académica

‘Failure to maintain’: care rationing and the clinical and financial burden of nurse sensitive hospital-acquired complications in complex older patients

Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.

A importância das academias no futebol de formação

Atualmente, as academias de futebol designam-se como uma estrutura de excelência com o objetivo de formar jogadores profissionais para a equipa principal, baseando-se não só na vertente desportiva, como também na vertente humana. As academias são um local de prática desportiva de qualidade, onde agentes especializados como professores, psicólogos e nutricionistas, estão presentes para que a evolução dos atletas seja exemplar. A criação de academias minimiza os gastos em atletas, pois estes são produzidos nestas instalações, moldando-os consoante as suas ambições, fazendo com que não haja uma necessidade na busca de jogadores de outros clubes, diminuindo assim o risco na compra de atletas que possam não conseguir adaptar-se ao clube ou demonstrem fraco rendimento no mesmo. O principal objetivo desta dissertação é compreender todo este funcionamento na academia e procurar perceber se todos estes fatores se sucedem. Posto isto, foi desenvolvido um inquérito respondido por 14 treinadores de academias de futebol existentes em clubes, tanto a nível nacional, como a nível internacional. Com este estudo foi possível concluir que muitas academias desenvolvem um trabalho notável e que muitas aproveitam todo este trabalho a longo prazo, usufruindo assim de benefícios financeiros para o clube.

Efficacy of Preoperative Chemotherapy in Treatment of Children With Wilms’ Tumor: A Meta-Analysis

Context: To assess the efficacy of preoperative chemotherapy in Wilms’ tumor patients and explore its true value for specific subgroups. Objectives: In the presence of these controversies, a meta-analysis that examines the efficacy of preoperative chemotherapy in Wilms’ tumor patients and specific subgroups is needed to clarify these issues. The objective of this meta-analysis is to assess the efficacy of preoperative chemotherapy in Wilms’ tumor patients and explore its true value for specific subgroups. Data Sources: Computer-based systematic search with “preoperative chemotherapy”, “Neoadjuvant Therapy” and “Wilms’ tumor” as search terms till January 2013 was performed. Study Selection: No language restrictions were applied. Searches were limited to randomized clinical trials (RCTs) or retrospective studies in human participants under 18 years. A manual examination of references in selected articles was also performed. Data Extraction: Relative Risk (RR) and their 95% Confidence Interval (CI) for Tumor Shrinkage (TS), total Tumor Resection (TR), Event-Free Survival (EFS) and details of subgroup analysis were extracted. Meta-analysis was carried out with the help of the software STATA 11.0. Finally, four original Randomized Clinical Trials (RCTs) and 28 retrospective studies with 2375 patients were included. Results: For preoperative chemotherapy vs. up-front surgery (PC vs. SU) group, the pooled RR was 9.109 for TS (95% CI: 5.109 - 16.241; P < 0.001), 1.291 for TR (95% CI: 1.124 - 1.483; P < 0.001) and 1.101 for EFS (95% CI: 0.980 - 1.238; P = 0.106). For subgroup short course vs. long course (SC vs. LC), the pooled RR was 1.097 for TS (95% CI: 0.784 - 1.563; P = 0.587), 1.197 for TR (95% CI: 0.960 - 1.493; P = 0.110) and 1.006 for EFS (95% CI: 0.910 - 1.250; P = 0.430). Conclusions: Short course preoperative chemotherapy is as effective as long course and preoperative chemotherapy only benefits Wilms’ tumor patients in tumor shrinkage and resection but not event-free survival.

Incidencia de hipoacusia y su relación con factores de riesgo, en pacientes del servicio de neonatología, Hospital Latinoamericano, Cuenca-Ecuador. 2015

ANTECEDENTES: Conocer el funcionamiento del sistema auditivo es de interés para los profesionales, por esto la detección temprana de hipoacusia es importante. OBJETIVO GENERAL: Determinar la incidencia de hipoacusia y su relación con factores de riesgo, en pacientes del Servicio de Neonatología, Hospital Latinoamericano, Cuenca - Ecuador, 2015. METODOLOGÍA: Es un estudio prospectivo analítico, la muestra de 50 pacientes cumplieron los criterios de inclusión y exclusión, los factores de riesgo se recolectaron en un formulario elaborado por los autores. Para la formulación y análisis de tablas estadísticas se utilizó Microsoft Office Excel 2007 y SPSS. Medidas Estadísticas: Riesgo Relativo, Índice de Confianza, y valor de P. RESULTADOS: La incidencia de hipoacusia detectada por OEA fue de 20 (40%) de 50 pacientes. El grupo etario con mayor incidencia de hipoacusia fueron pacientes entre 1 y 5 días de nacidos. Los factores de riesgo más frecuentes fueron PREMATURIDAD y APGAR al minuto deprimido, ambos con 28 casos (56%). El sexo MASCULINO con un 60% del total de hipoacusias detectadas fue el de mayor incidencia. Los factores de riesgo estadísticamente significativos, fueron MANIFESTACIONES NEUROLÓGICAS, con un RR=3.31 (IC95%: 2.10 – 5.21) y valor p = 0.001 y MALFORMACIONES CONGENITAS con un RR=2.88 (IC95%: 1.94 – 4.27) y valor p=0.021. CONCLUSIONES: Determinar la incidencia de hipoacusia mediante OEA es importante para llegar a un diagnóstico definitivo mediante la prueba de Potenciales Evocados y lograr un tratamiento temprano y adecuado, además de un control epidemiológico propio para detectar factores de riesgo asociados

Thermodynamic calculations for the salt crystallisation damage in porous built heritage using PHREEQC

This work considers the crystallisation mechanisms of the most common and aggressive salts that generate stress in porous building stones as a result of changing ambient conditions. These mechanisms include the salt crystallisation that result from decreasing relative humidity and changes in temperature and, in hydrated salts, the dissolution of the lower hydrated form and the subsequent precipitation of the hydrated salt. We propose a new methodology for thermodynamic calculations using PHREEQC that includes these crystallisation mechanisms. This approach permits the calculation of the equilibrium relative humidity and the parameterization of the critical relative humidity and crystallisation pressures for the dissolution–precipitation transitions. The influence of other salts on the effectives of salt crystallisation and chemical weathering is also assessed. We review the sodium and magnesium sulphate and sodium chloride systems, in both single and multicomponent solutions, and they are compared to the sodium carbonate and calcium carbonate systems. The variation of crystallisation pressure, the formation of new minerals and the chemical dissolution by the presence of other salts is also evaluated. Results for hydrated salt systems show that high crystallisation pressures are possible as lower hydrated salts dissolve and more hydrated salts precipitate. High stresses may be also produced by decreasing temperature, although it requires that porous materials are wet for long periods of time. The presence of other salts changes the temperature and relative humidity of salt transitions that generates stress rather than reducing the pressure of crystallisation, if any salt has previously precipitated. Several practical conclusions derive from proposed methodology and provide conservators and architects with information on the potential weathering activity of soluble salts. Furthermore, the model calculations might be coupled with projections of future climate to give as improved understanding of the likely changes in the frequency of phase transitions in salts within porous stone.

Prevalence of diabetic retinopathy in type II diabetic patients in a health facility in Karachi, Pakistan

Purpose: To study the prevalence of diabetic retinopathy in known diabetic patients attending the diabetes outpatient department (OPD) of Sind Government Hospital (SGH), New Karachi Township (NKT), Pakistan. Methods: A cross-sectional observational study was carried out at the diabetic OPD of SGH, NKT over the period of 17 months from March 2013 to August 2014. The selected patients were interviewed based on a questionnaire; laboratory investigations were performed and examination of the eye was conducted by a specialist ophthalmologist. One hundred and fifty four (154) subjects out of 305 patients contacted fully completed the study. Stratification of the data on gender basis was done, after which one-way ANOVA, χ2 test of correlation, binary logistic regression and relative risk analyses were carried out using SPSS-20. Results: It was found that 66 % men of normal weight (χ2 = 4.667, p < 0.05) and 60.7 % overweight women (χ2 = 5.143, p < 0.05) were more likely to present with diabetic retinopathy (DR). Prevalence of DR in this target population was 42.86 % (N = 66). Background DR (56 %) and maculopathy (23 %) were more prevalent than advanced conditions of the disease. There was no gender-based preponderance for the presentation of DR (χ2 = 0.663; p > 0.05), nor was this seen in different ethnic groups. Conclusion: DR is prevalent in the target population and, therefore, emphasis should be on the education of the local population of New Karachi Township on how to attain euglycemic state with regular medication, diet and exercise to avoid development and progress of DR.

Therapeutic efficacy of alternative primaquine regimens to standard treatment in preventing relapses by Plasmodium vivax : A systematic review and meta-analysis

Objective: To compare efficacy and safety of primaquine regimens currently used to prevent relapses by Plasmodium vivax. Methods: A systematic review was carried out to identify clinical trials evaluating efficacy and safety to prevent malaria recurrences by P. vivax of primaquine regimen 0.5 mg/kg/day for 7 or 14 days compared to standard regimen of 0.25 mg/kg/day for 14 days. Efficacy of primaquine according to cumulative incidence of recurrences after 28 days was determined. The overall relative risk with fixed-effects meta-analysis was estimated. Results: For the regimen 0.5 mg/kg/day/7 days were identified 7 studies, which showed an incidence of recurrence between 0% and 20% with follow-up 60-210 days; only 4 studies comparing with the standard regimen 0.25 mg/kg/day/14 days and no difference in recurrences between both regimens (RR= 0.977, 95% CI= 0.670 to 1.423) were found. 3 clinical trials using regimen 0.5 mg/kg/day/14 days with an incidence of recurrences between 1.8% and 18.0% during 330-365 days were identified; only one study comparing with the standard regimen (RR= 0.846, 95% CI= 0.484 to 1.477). High risk of bias and differences in handling of included studies were found. Conclusion: Available evidence is insufficient to determine whether currently PQ regimens used as alternative rather than standard treatment have better efficacy and safety in preventing relapse of P. vivax. Clinical trials are required to guide changes in treatment regimen of malaria vivax.

Therapeutic efficacy of alternative primaquine regimens to standard treatment in preventing relapses by Plasmodium vivax: A systematic review and meta-analysis

Objective: To compare efficacy and safety of primaquine regimens currently used to prevent relapses by Plasmodium vivax. Methods: A systematic review was carried out to identify clinical trials evaluating efficacy and safety to prevent malaria recurrences by P. vivax of primaquine regimen 0.5 mg/kg/day for 7 or 14 days compared to standard regimen of 0.25 mg/kg/day for 14 days. Efficacy of primaquine according to cumulative incidence of recurrences after 28 days was determined. The overall relative risk with fixed-effects meta-analysis was estimated. Results: For the regimen 0.5 mg/kg/day/7 days were identified 7 studies, which showed an incidence of recurrence between 0% and 20% with follow-up 60-210 days; only 4 studies comparing with the standard regimen 0.25 mg/kg/day/14 days and no difference in recurrences between both regimens (RR= 0.977, 95% CI= 0.670 to 1.423) were found. 3 clinical trials using regimen 0.5 mg/kg/day/14 days with an incidence of recurrences between 1.8% and 18.0% during 330-365 days were identified; only one study comparing with the standard regimen (RR= 0.846, 95% CI= 0.484 to 1.477). High risk of bias and differences in handling of included studies were found. Conclusion: Available evidence is insufficient to determine whether currently PQ regimens used as alternative rather than standard treatment have better efficacy and safety in preventing relapse of P. vivax. Clinical trials are required to guide changes in treatment regimen of malaria vivax.

Économie comportementale : retrouve-t-on un effet d’ancrage dans la LNH ?

De par leur nature scientifique, les sciences économiques visent, entre autre, à observer, qualifier, ainsi que quantifier des phénomènes économiques afin de pouvoir en dégager diverses prévisions. Ce mémoire se penche sur ces prévisions et, plus particulièrement, sur les facteurs pouvant biaiser les prévisionnistes au niveau comportemental en référant à l’effet d’ancrage, un biais propre à l’économie comportementale – une sous-discipline des sciences économiques. Il sera donc question de comprendre, par une analyse selon la discipline que représente l’économie comportementale, ce qui peut les affecter, avec un accent mis sur l’effet d’ancrage plus précisément. L’idée générale de ce dernier est qu’un agent peut être biaisé inconsciemment par la simple connaissance d’une valeur précédente lorsqu’il est demandé de faire une estimation ultérieure. De cette façon, une analyse des salaires des joueurs de la Ligne Nationale de Hockey (NHL) selon leurs performances passées et leurs caractéristiques personnelles, de 2007 à 2016, a été réalisée dans ce travail afin d’en dégager de possibles effets d’ancrage. Il est alors possible de constater que les directeurs généraux des équipes de la ligue agissent généralement de façon sensible et rationnelle lorsque vient le temps d’octroyer des contrats à des joueurs mais, néanmoins, une anomalie persiste lorsqu’on porte attention au rang auquel un joueur a été repêché. Dans un tel contexte, il semble pertinent de se référer à l’économie comportementale afin d’expliquer pourquoi le rang au repêchage reste une variable significative huit ans après l’entrée d’un joueur dans la NHL et qu’elle se comporte à l’inverse de ce que prévoit la théorie à ce sujet.

Childhood drowning and near-drowning in Brisbane: The contribution of domestic pools

To describe the epidemiology of domestic swimming pool drowning and near-drowning in Brisbane and to examine the efficacy of a broad range of preventive options, including pool fences.A prospective, hospital-based, injury surveillance system to describe the epidemiology of drowning and near-drowning and a community survey to describe pool fencing.The surveillance questionnaire was completed at presentation in the Emergency Department by the parent, nurse and doctor. Personal interviews in households that were randomly selected by means of a stratified sampling scheme provided the pool fencing description.All 139 children suffering from an immersion injury resulting in presentation at a hospital in the catchment area of The Mater Children's Hospital were included. There were 204 households with a swimming pool in the 1024 households interviewed in the community survey.The 100 domestic pool drownings and near-drownings were equivalent to 15.5 incidents per year per 100,000 children aged 0-13 years and 64.9 per year per 100,000 for the critical 1-3 years age group. Of 72 children who gained unintended access to a domestic pool, 88.9% were less than 3 years of age and 52.8% were less than 2 years. All 10 of the children who drowned and five who were severely brain damaged (age range, 12-32 months) were in this group. The risk of a drowning or near-drowning involving unintended access to an unfenced pool is 3.76 times higher than the risk associated with a fenced pool (95% confidence limits for relative risk: 2.14, 6.62).Pool fences are an effective method of preventing child drownings and near-drownings. This effectiveness can be further improved if compliance with gate closure can be enhanced. This should be emphasised in health promotion accompanying the introduction of universal pool fencing. Article in The Medical journal of Australia 154(10):661-5 · June 1991

Économie comportementale : retrouve-t-on un effet d’ancrage dans la LNH ?

De par leur nature scientifique, les sciences économiques visent, entre autre, à observer, qualifier, ainsi que quantifier des phénomènes économiques afin de pouvoir en dégager diverses prévisions. Ce mémoire se penche sur ces prévisions et, plus particulièrement, sur les facteurs pouvant biaiser les prévisionnistes au niveau comportemental en référant à l’effet d’ancrage, un biais propre à l’économie comportementale – une sous-discipline des sciences économiques. Il sera donc question de comprendre, par une analyse selon la discipline que représente l’économie comportementale, ce qui peut les affecter, avec un accent mis sur l’effet d’ancrage plus précisément. L’idée générale de ce dernier est qu’un agent peut être biaisé inconsciemment par la simple connaissance d’une valeur précédente lorsqu’il est demandé de faire une estimation ultérieure. De cette façon, une analyse des salaires des joueurs de la Ligne Nationale de Hockey (NHL) selon leurs performances passées et leurs caractéristiques personnelles, de 2007 à 2016, a été réalisée dans ce travail afin d’en dégager de possibles effets d’ancrage. Il est alors possible de constater que les directeurs généraux des équipes de la ligue agissent généralement de façon sensible et rationnelle lorsque vient le temps d’octroyer des contrats à des joueurs mais, néanmoins, une anomalie persiste lorsqu’on porte attention au rang auquel un joueur a été repêché. Dans un tel contexte, il semble pertinent de se référer à l’économie comportementale afin d’expliquer pourquoi le rang au repêchage reste une variable significative huit ans après l’entrée d’un joueur dans la NHL et qu’elle se comporte à l’inverse de ce que prévoit la théorie à ce sujet.