Common pediatric surgical diseases of refugee children: health around warzone.

PURPOSE: We aim to evaluate the sociodemographic and medical features of child-aged refugee patients and identify their health-related problems. METHODS: Refugee children admitted to pediatric surgery department of a teaching hospital during the years 2012-2017 were included. Patients' files were reviewed retrospectively for sociodemographic and medical features. RESULTS: A total of 254 patients with the mean age of 4.6 ± 4.15 years (0-16 years) were treated. Male-to-female ratio was 1.7. Most common diagnosis were inguino-scrotal pathologies (n = 50, 19.7%) followed by foreign body ingestion (n = 37, 14.6%) and corrosive esophagitis (n = 22, 8.7%). The cause of admission was a potentially preventable trauma in 24.4% of cases. Comorbid medical conditions were present in 49 patients (19.3%). Anemia was detected in 23.2% of cases. Weight according to age and gender were < 3 percentile in 29.1% of patients. Difficulties in communication, lack of former medical history and advanced presentation of disease were the challenges faced by caregivers. CONCLUSION: The primary diagnoses for admission of refugee children were different from the routine practice and a significant part were from preventable causes. Comorbidities were common potentially having a negative influence on treatment processes. This can be a result of unfavorable living conditions and lack of medical care during migration.

Age, Sex, Health Insurance, and Race Associated With Increased Rate of Emergent Pediatric Gastrointestinal Procedures.

OBJECTIVES: Few studies have examined the role health disparities play in pediatric gastrointestinal (GI) procedures. We hypothesized that health disparity factors affect whether patients undergo an emergent versus nonemergent GI procedure. The aims were to characterize the existing pediatric population undergoing GI procedures at our institution and assess specific risk factors associated with emergent versus nonemergent care. METHODS: We retrospectively reviewed the medical records of 2110 patients undergoing GI procedures from January 2012 to December 2014. Emergent procedures were performed on an urgent inpatient basis. All other procedures were considered nonemergent. Health disparity factors analyzed included age, sex, insurance type, race, and language. Logistic regression analysis identified the odds of undergoing emergent procedures for each factor. RESULTS: Most study patients were boys (58.2%), primarily insured by Medicaid (63.8%), white (44.0%), and spoke English (91.7%). Ten percent of all patients had an emergent procedure. Logistic regression analysis showed significant odds ratios (P value) for ages 18 years older (2.16, 0.003), females (0.62, 0.001), commercial insurance users (0.49, <0.0001), African Americans (1.94, <0.0001), and other race (1.72, 0.039). CONCLUSIONS: Health disparities in age, sex, insurance, and race appear to exist in this pediatric population undergoing GI procedures. Patients older than 18 years, African Americans, and other races were significantly more likely to have an emergent procedure. Girls and commercial insurance users were significantly less likely to have an emergent procedure. More research is necessary to understand why these relations exist and how to establish appropriate interventions.

Contributions to the phytotherapies of digestive disorders: Traditional knowledge and cultural drivers of Manoor Valley, Northern Pakistan.

ETHNO PHARMACOLOGICAL RELEVANCE: Ethno medicinal traditional knowledge regarding the uses of indigenous medicinal plants used for various human digestive disorders are mostly known to the elder community members. As the young generation is not much aware about such vital traditional medicinal practice because they rely on elders. AIM OF STUDY: To document, accumulate and widely disseminate the massive indigenous knowledge of century's practiced therapeutic uses of medicinal plants by the local people living in this remote area. MATERIALS AND METHODS: A total of 63 local inhabitants (39 males and 24 females) were interviewed through a structured questionnaire. The data obtained were quantitatively analyzed through the use value (UVi), fidelity level index (FL%) and relative frequency citations (RFCs), consensus index (CI%) and informant consensus factor (FIC). For novel uses all the plants were checked with previously published articles on same disease by analyzing through Jaccard index (JI) and Sorensen's similarity index (QS). Plants specimen were preserved, mounted and labeled on the herbarium sheets, cataloged and deposited with voucher numbers in Hazara University Herbarium, Mansehra, Pakistan (HUP). RESULTS: 44 plant species belonging to 44 genera and 28 families were documented in the current study. These medicinal plant species were used commonly as an ethno medicine against 26 various digestive disorders out of which most frequently occurred are; stomach ache, diarrhea, indigestion, constipation and inflammation etc. Herbaceous plant species were the dominant among plants studied which were 64% of the total plants, followed by trees (20%) and shrubs (16%). Lamiaceae was the leading family among collected medicinal plant species (13.6%). Maximum medicinal plant species were used for treatment of stomach ache (11.7%), diarrhea and indigestion (10.9% each). Most widely used parts were leaves (41% citations), fruit and whole plant (12% citations each) for medication of various digestive problems by the traditional drivers. Dominated medicinal plants with most use values were Ficus carica having (UVi=0.90) and Trifolium repens (UVi=0.84). Based on the RFC values, the most cited medicinal plant species by the traditional drivers were Ficus carica (0.43) and Berberis lycium (0.41), while most respondents percentage was noticed for same plant species calculated through consensus index (CI%=42.9% and 41.3%) respectively. The medicinal plant species with highest fidelity level was of Grewia optiva, Juglans regia and Sorbaria tomentosa each cited 100% for anthelmintic, easy digestion and Diarrhea respectively. Due to representation by only single medicinal plant taxa (Nt=1), the digestive diseases viz. cholera, colon cancer, emetic, internal injuries, kill microorganisms, Soothing, tumor and urine suppression had maximum FIC value. The analytical result reveals that 57% of medicinal plant species were reported for the first time regarding their uses. new medicinal uses of Anaphalis contorta, Caltha palustris, Pinus wallichiana, Plantago himalaica were recorded for the first time from Pakistan and Aralia cachemirica, Bupleurum longicaule, Pleurospermum stellatum, Potentilla argentea and Juglans regia across the globe for currently reported medicinal uses. Besides this, all the mentioned plant species were reported for the first time for digestive disorders from Manoor Valley as no single study up-till now has been conducted ethno medicinally. CONCLUSION: The present study revealed the importance to document and launch list of all the possible plants that are used in traditional medicinal practices against digestive disorders in the unexplored study area and to show the important medicinal plants for future biological, phytochemical and pharmacological experimentation regarding digestive problems.

Traditional preference of Wild Edible Fruits (WEFs) for digestive disorders (DDs) among the indigenous communities of Swat Valley-Pakistan.

ETHNOPHARMACOLOGICAL RELEVANCE: Digestive disorders (DDs) causes indisposition and lead to death, especially in the underdeveloped world where hygienic conditions are scarce. A major proportion of the human populace depends on the use of traditional knowledge about the consumption of medicinal plants for many diseases, including DDs. The contemporary study summarizes the indigenous uses of Wild Edible Fruits (WEFs) of Swat Valley used for DDs and to evaluate the bio-efficacy of these pharmacologically essential fruit species from the available literature. MATERIAL AND METHODS: An ethnomedicinal study was conducted in Swat valley, Northern Pakistan. Data was collected through field assessment as well as from traditional healers and local people by means of personal interviews and semi-structured questionnaires, giving value to both rural and urban communities. The ethnomedicinal knowledge was quantitatively analysed using various indices like Familiarity Index (FI), Consensus index (CI), Informant consensus factor (ICF) and the present data was compared with previous studies in the neighbouring areas using Jaccard similarity coefficient (JI). RESULTS: The present study recorded use reports on 53 WEFs of ethnomedicinal prominence in the treatment of DDs, belonging to 23 families. The recurrent growth forms were trees (51%) shrubs (38%) and herbs (11%). High consumption of fruits (50%), leaves (27%) and flowers (12%) was recorded. The traditional preparations were mostly in the form of unprocessed dried/fresh, powder, Juice and decoction and were usually taken orally. Almost 20-30% of the plants occurred in synanthropic vegetation while more than 75% were found in natural woodland and grassland vegetation. Family Berberidaceae dominated with highest FIV (41) followed by Punicaceae (38), Oxalidaceae (36) and Moraceae (35). ICF values for carminative (0.6) showed high consensus factor followed by anthelmintic, gastroenteritis and intestinal disorders (0.5). FI value is high for Berberis lycium (0.5), Morus alba (0.5), Morus nigra (0.5) followed by Olea ferruginea (0.45). B. lycium had the high consensus index, whereas, a study conducted on Lesser Himalayas Pakistan showed high value of Jaccard similarity coefficient. CONCLUSION: WEFs are predominantly used in the treatment of various diseases in the valley and traditional knowledge about the use of these species against DDs is still prevailing. Multiple uses of these WEFs suggest further investigation into its phytochemical, toxicological and pharmaceutical potential. This study will serve as a baseline data for future pharmacological studies.

Translation and psychometric evaluation of the Chinese version of functional digestive disorders quality of life questionnaire.

BACKGROUND: Few useful patient-reported outcomes scales for functional dyspepsia exist in China. AIMS: The purpose of this work was to translate and cross-culturally adapt the Functional Digestive Disorders Quality of Life Questionnaire (FDDQL) from the English version to Chinese (in Mandarin). METHODS: The following steps were performed: forward translations, synthesis of the translations, backward translations, pre-testing and field testing of FDDQL. Reliability, validity, responsiveness, confirmatory factor analysis, item response theory and differential item functioning of the scale were analyzed. RESULTS: A total of 300 functional dyspepsia patients and 100 healthy people were included. The total Cronbach's alpha was 0.932, and split-half reliability coefficient was 0.823 with all test-retest coefficients greater than 0.9 except Coping With Disease domain. In construct validity analysis, every item correlated higher with its own domain than others. The comparative fit index of FDDQL was 0.902 and root mean square error of approximation was 0.076. Functional dyspepsia patients and healthy people had significant differences in all domains. After treatment, all domains had significant improvements except diet. Item response theory analysis showed the Person separation index of 0.920 and the threshold estimator of items was normally distributed with a mean of 0 and standard deviation of 1.27. The residuals of each item were between -2.5 and 2.5, without statistical significance. Differential item functioning analysis found that items had neither uniform nor non-uniform differential item functioning in different genders and age groups. CONCLUSIONS: The Chinese version of FDDQL has good psychometric properties and is suitable for measuring the health status of Chinese patients with functional dyspepsia.

Effects of race and insurance on outcomes of the open abdomen.

Recent studies have suggested improved outcomes in surgical patients with healthcare insurance, whereas several others have noted disparities in access to health care, the care provided, and the aftercare of uninsured patients. Several different strategies exist in the management and prevention of the open abdomen secondary to abdominal compartment syndrome. To date, no study has evaluated the effects of race and insurance in patients with an open abdomen (OA). A retrospective review from our OA database was queried. All patients with an OA from January 2002 to December 2010 were included for analysis. Data analyzed included patients' demographics, race, insurance status, hospital charges, Injury Severity Scores, and outcomes. Insured patients were identified and compared with their uninsured counterparts. A total of 720 patients were treated for an OA during the study period. Of these, 273 (37.9%) died within their hospital stay. Patients who died were noted to be older and sicker with higher Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiologic Scores (27.6 vs. 18.2, P < 0.001 and 54.6 vs. 38.5, P < 0.001, respectively). Logistic regression analysis revealed that age, APACHE II, and Injury Severity Scores were independently associated with mortality. From our categorical variables, race was not associated with worse outcomes. In addition, being uninsured was significantly associated with increased mortality (odds ratio, 1.67; 95% confidence interval, 1.1 to 2.6; P = 0.05). "Self-pay" status was associated with increased mortality even after adjusting for severity of illness. Further studies incorporating baseline comorbidities need to be undertaken to further assess the reasons for these disparities.

[Analysis of illness pathology causes of digestive organs in the Chuvash Republic and prospects of its reduction].

The main principles of organization of gastroenterological service of the Chuvash Republic are presented. The main significant causes of incidence rate of digestive apparatus pathology and the ways of their elimination are discussed. The peculiarities of population dietary habits are analyzed. The complex of measures carried out in Chuvashia for improving the quality of production and processing of alimentary products taking into account the peculiarities of every biogeochemical subregion and requirements of various population groups is presented. The forms and methods of healthy life-style formation, training of people responsible attitude to their health are described. Priority guidelines of gastroenterological assistance to the population of the Chuvash Republic are enumerated.

Chronic diseases and dietary changes in relation to Korean Americans' length of residence in the United States.

BACKGROUND: National health in the United States is influenced by the dietary norms brought into the country by an increasing number of immigrants. OBJECTIVES: This cross-sectional study aimed to document dietary changes and disease prevalence in relation to the length of residence in the United States for Korean Americans in Michigan. DESIGN: Of 1,860 questionnaires mailed out, 637 (34.3%) were returned with respondent-reported information, including demographics, weight and height, chronic diseases, and dietary patterns. SUBJECTS/SETTING: Included in the final analyses were 497 first-generation Korean-American immigrants (263 men, 234 women, aged 30 to 87 years). STATISTICAL ANALYSES PERFORMED: Analysis of covariance with the Tukey test and logistic regression models provided sex-specific analysis of dietary changes and disease patterns. All statistical analyses were adjusted for age. RESULTS: Chronic diseases reported most frequently by men and women, respectively, were hypertension, digestive diseases, arthritis, and diabetes. Length of residence in the United States (or=26 years) was inversely associated with the prevalence of digestive diseases in men (P=0.017) and women (P=0.001), and positively with respiratory diseases in men and thyroid disease in women (P<0.05). Length of residence in the United States was inversely associated with intake of rice/rice dishes in both men (servings per week, P<0.001) and women (P=0.012). The prevalence of digestive diseases associated inversely with length of residence and positively with servings of rice/rice dishes consumed for Korean-American men. The age-adjusted odds ratio for digestive diseases was highest among men who had the shortest length of residence in the United States (2 servings per day) (odds ratio 12.10; P=0.03). CONCLUSIONS: Dietary changes of Korean-American immigrants in the United States over time were associated with changes in their chronic disease patterns. These findings may help food and nutrition professionals who work with minority immigrants because they identify factors that affect changes in dietary patterns and work toward preventing diet-related diseases. Prospective studies could address underlying mechanisms of the observed diet-disease relationship with subsequent generations of Korean Americans, as well as various ethnic minority immigrants in the United States.

Disease profiles in Chinese in Hong Kong: an analysis of the primary diagnoses in 561 acute hospital medical admissions.

Little is known about the disease profiles in Chinese living in an urbanized community like Hong Kong. Accordingly, the discharge summaries of 561 acute hospital medical admissions were reviewed and the primary diagnoses (the main reason for admission or the most important clinical problem) were coded according to the International Classification of Diseases. Our data indicate that cardiovascular diseases are the most important cause of acute medical admissions and mortality and that gastrointestinal hemorrhage is very common amongst the Chinese in Hong Kong.