Anaesthesia for ear surgery in remote or resource-constrained environments.

BACKGROUND: The successful provision of middle-ear surgery requires appropriate anaesthesia. This may take the form of local or general anaesthesia; both methods have their advantages and disadvantages. Local anaesthesia is simple to administer and does not require the additional personnel required for general anaesthesia. In the low-resource setting, it can provide a very safe and effective means of allowing middle-ear surgery to be successfully completed. However, some middle-ear surgery is too complex to consider performing under local anaesthesia and here general anaesthesia will be required. CONCLUSION: This article highlights considerations for performing middle-ear surgery in a safe manner when the available resources may be more limited than those expected in high-income settings. There are situations where local anaesthesia with sedation may prove a useful compromise of the two techniques.

Primary care groups. Serving from the shadows.

A study of appointments to the boards of 59 PCGs covered by the 13 health authorities in the West Midlands found concerns about fairness, openness and transparency. There was concern about the lack of a competency framework for GP members. Health authorities questioned whether the lay members of boards were representative of the local population. Some health authorities provided no induction training for boards.

Impact of migration, environment and socioeconomic conditions on blood pressure of Sikhs.

This study documents the impact of migration, environment and caste on the blood pressure of Sikhs living in the UK and their peers in the native Punjab state of India. A sample of 449 adult Sikhs, males and females, were studied in the Punjab state, and in Southall, in the Ealing borough of London and Handsworth in Birmingham in the UK. There is minor variation in the blood pressure of members of various castes among the Sikhs living in the Punjab. The pattern in blood pressure broadly corresponds with the economic status of the individuals, with well-off groups showing higher blood pressure compared to the poorer groups. The blood pressure of migrants, though higher than that of their sedente peers, is not significantly so. Age at arrival in the UK and the length of exposure to the new environment were generally not significantly related to variation in blood pressure. There seems to be a secular shift in the blood pressure values of the native Punjabi Sikhs compared to earlier studies, possibly because of the rise in civic disturbances and social unrest in the Punjab during recent years.

A study of dietary practices of pre-school children attending anganwadies in urban slum of Patiala (Punjab).

PIP: In India, interviews with mothers of 3-5 year old children living in the Badungarh slum of Patiala City in the Punjab were conducted at 4 anganwadies of the Integrated Child Development Services. The aim of the study was to determine the children's nutritional status. Anganwadies provided the same food supplement daily to 3-5 years old children. The amount provided was less than the recommended amount, however. 75% of the children were not vegetarians. Many children did not like pumpkin brinjal, spinach, and other leafy vegetables. Children's intake of cereals, pulses, green leafy vegetables, milk and milk products, meat, fish and eggs, sugar and jaggery, and fats and oils was lower than recommended allowances. The low intake of meat, fish, and eggs was likely due to the families low income. Consumption of cereals and pulses together resulted in adequate protein intake, but the low intake of leafy vegetables, milk, egg, meat, fish, and fruits resulted in insufficient intake of calcium and bete-carotene. Caloric intake was lower among the 4-5 year olds than among the 3-4 year olds (831.7 vs. 858.9 Kcal). Mothers tended to take the food supplements home to share with all the children in the households. These findings led the researchers to recommend that children eat different and more tastier types of food supplements at the anganwadies. Other recommendations include more frequent checks of food supplement stocks and better supervision.^ieng