NB housing study protocol: investigating the relationship between subsidized housing, mental health, physical health and healthcare use in New Brunswick, Canada.

BACKGROUND: Income and housing are pervasive social determinants of health. Subsidized housing is a prominent affordability mechanism in Canada; however, waitlists are lengthy. Subsidized rents should provide greater access to residual income, which may theoretically improve health outcomes. However, little is known about the health of tenants who wait for and receive subsidized housing. This is especially problematic for New Brunswick, a Canadian province with low population density, whose inhabitants experience income inequality, social exclusion, and challenges with healthcare access.  METHODS: This study will use a longitudinal, prospective matched cohort design. All 4,750 households on New Brunswick's subsidized housing wait list will be approached to participate. The survey measures various demographic, social and health indicators at six-month intervals for up to 18 months as they wait for subsidized housing. Those who receive housing will join an intervention group and receive surveys for an additional 18 months post-move date. With consent, participants will have their data linked to a provincial administrative database of medical records.  DISCUSSION: Knowledge of housing and health is sparse in Canada. This study will provide stakeholders with a wealth of health information on a population that is historically under-researched and underserved.

Concurrent validity of the Learning and Study Strategies Inventory (LASSI): a study of African American precollege students.

Concurrent validation procedures were employed, using a sample of African American precollege students, to determine the extent to which scale scores obtained from the first edition of the Learning and Study Strategies Inventory (LASSI) were appropriate for diagnostic purposes. Data analysis revealed that 2 of the 10 LASSI scales (i.e., Anxiety and Test Strategies) significantly correlated with a measure of academic ability. These results suggested that scores obtained from these LASSI scales may provide valid assessments of African American precollege students' academic aptitude. Implications for teachers, school counselors, and developmental studies professionals were discussed.

Randomised controlled trial of two models of care for discharged psychiatric patients.

OBJECTIVE: To compare the clinical outcome and costs of care of psychiatric patients allocated to community multidisciplinary teams or to hospital based care programmes after discharge from inpatient care. DESIGN: Randomised controlled trial. SETTING: Inner London (Paddington and North Kensington) and outer London (Brent) psychiatric services. SUBJECTS: 155 patients with severe mental illness with a previous admission within the past 2 years. MAIN OUTCOME MEASURES: Ratings of clinical psychopathology, depression, anxiety, and social functioning; comprehensive costs of health care. RESULTS: Clinical outcomes were available for 133 patients and cost data for 144 patients after 1 year. The clinical outcomes of the two models of care were essentially similar, but admission to hospital was more likely in the hospital based care group and the costs of health care were 14% greater per patient than in the community group. This difference, however, was dwarfed by a twofold difference in the costs of care in the outer London services compared with those in inner London. This was explained largely by greater inpatient care for outer London patients (58 median bed days v 18 for inner London patients), more of which was provided by extracontractual referrals to other psychiatric hospitals as Brent had only 0.28/1000 beds available for acute adult patients compared with 0.82/1000 in Paddington and North Kensington over the period of the study. CONCLUSION: Aftercare by community teams for psychiatric patients with severe mental illness has a similar outcome to hospital based aftercare but with fewer admissions to hospital. When psychiatric bed requirements are insufficient for a population, however, neither form of aftercare is effective as greater use of hospital beds elsewhere swamps any advantage of community care programmes, with disintegration and discontinuity of psychiatric services leading to escalating costs.

AIDS in Africa: what drugs do the carers want or need?

Our objectives were: (1) to discover requirements for treatment of patients with AIDS (PWAs) for health-care workers in eight English-speaking African countries; (2) to establish policies for supply of drugs, and develop a method for determining the contents of parcels (PWA-BOXes) for the relief of PWAs. Fifty-seven questionnaires were sent to non-government medical units treating PWAs, supplied by the charity Inter Care. Of these 37 units replied, two had no known PWAs, three were swamped by refugees; therefore, the total number analysed was 32. Only 24 units had access to HIV testing and the mean number of PWAs per unit was 58. The reported complications of AIDS were: diarrhoea 28 units; tuberculosis 27 units; pneumonia 28 units; sexually transmitted diseases 26; candidiasis 28 units; and herpes zoster 20. Lists of drug requirements were received. We present a protocol for calculation of contents of PWA-BOXes in the hope that this will provide guidelines for other workers in this field.

PIP: Inter Care, a UK charitable organization, provides essential drugs to 120 medical units in Africa. To upgrade support to units caring for substantial numbers of acquired immunodeficiency syndrome (AIDS) patients, Inter Care sent a questionnaire to 57 of its small rural hospitals and health and maternity units. Of the 37 units that returned the questionnaire, 24 reported access to human immunodeficiency virus (HIV) laboratory tests while another seven relied on clinical diagnostic methods. The number of AIDS patients treated per month ranged from 0 to 200 (mean, 50). Diseases and conditions most commonly associated with AIDS included diarrhea, pneumonia, candidiasis, tuberculosis, and sexually transmitted diseases. The most commonly used drugs were metronidazole, micronazole oral gel, and oxytetracycline. On the basis of these findings, Inter Care was able to modify the contents of AIDS boxes provided to its affiliates. An assumption was made that a patient with AIDS spends only two weeks in the hospital before death given the rapid progression of the disease in Africa. The drugs supplied vary according to specific requests and the type of facility, but seek to treat the AIDS-related conditions identified in the survey with the least expensive drug available. Also provided, depending on need, are HIV test kits and educational posters.

Ultrasound assessment of liver and kidney brightness in infants. Use of the gray-level histogram.

RATIONALE AND OBJECTIVES: Ultrasonic image analysis aims to provide information related to tissue histology. Routine ultrasonography uses subjective criteria for analysis. Quantitation of the image is expected to aid diagnosis and may be helpful in follow-up of pathology. The authors describe normal findings in infant liver and kidney. METHODS: Texture parameters derived from the gray-level histogram and the first order statistics from the ultrasound images of the liver, right kidney, and a tissue-mimicking phantom in 50 newborn infants were studied. RESULTS: A set of normal values for mean and standard deviation of the histogram for infant liver and kidney was established. Results of a time-related study indicate that in infants the liver is not a good internal standard for tissue characteristic comparison. CONCLUSIONS: The method described and results obtained provide a basis of normality for further studies of pathology in infant renal and hepatic disease.

Real time ultrasonography in the assessment of movement at the site of a scaphoid fracture non-union.

We investigated the use of real time linear ultrasonography in determining movement at a scaphoid fracture site in 27 patients with non-united scaphoid fractures. 24 of these patients had surgical treatment. Fracture movement was observed at the time of surgery and this was compared with the ultrasonographic findings. The technique proved to be 100% specific for visualization of movement at the fracture site and it was non-invasive. However, it was of no benefit in assessing proximal pole non-union.

The reliability of ultrasonographic assessment of neonatal hips.

Ultrasound scans were made of the hips of 209 neonates born consecutively over a two-week period. Of the 418 scans, 62 images were selected at random and 25 of these were duplicated to give a total of 87 scans. These static images were then presented to five experienced observers who each made nine different assessments and measurements. Interobserver and intraboserver agreement was calculated and expressed as kappa values. Our results showed poor reliability on both counts.

Ultrasound assessment of renal cortical brightness in infants: is naked eye evaluation reliable?

Twenty observers estimated renal cortical brightness compared with the liver in 28 ultrasound images. Their judgment was compared with objective densitometer readings. High inter- and intra-observer variation was found. Estimates of brightness of ultrasound images by eye alone should be interpreted with care.

Assessment of clinical criteria for identification of severe acute lower respiratory tract infections in children.

222 acute lower respiratory tract infections (LRI), as defined by the World Health Organisation, were identified during one year's surveillance of a cohort of 500 Gambian children aged 0 to 4 years. Symptoms and signs at presentation were related to radiological evidence of lobar consolidation, indicating severe LRI. In infants, a fever of greater than 38.5 degrees C, refusal to breast-feed, or the presence of vomiting were the best predictors of severe LRI. In children aged 1 to 4 years, a fever of greater than 38.5 degrees C or a respiratory rate greater than 60/min were the most accurate clinical signs for severe LRI. Chest indrawing did not discriminate severe LRI. These community-based findings differ from results of hospital-based studies.

Direct endoscopic assessment of cleft palate repairs.

The value of nasopharyngeal endoscopy in assessing the function of the soft palate in speech is discussed. The apparatus required and the method used are both described in some detail. The view through the endoscope in relation to the normal and abnormal palatal functions is reviewed.

An evaluation of the Celloscope 401 electronic blood cell counter.

For counting erythrocytes the instrument was precise, with a mean coefficient of variation of 1.21%. Erythrocyte counts showed close agreement with results obtained on a Coulter A electronic counter of proven accuracy. When the Celloscope 401 was modified by the manufacturers to eliminate electrical interference from other laboratory equipment, satisfactory precision and accuracy for white cell counting was obtained. Using cetrimide diluent the coefficient of variation was 1.6% but when using saponin/saline diluent the coefficient of variation was 3.5%. For leucocyte counting there was close agreement between duplicate tests performed on the Celloscope 401 and the Coulter S. The instrument was capable of satisfactory precision and accuracy in platelet counting, provided that the sedimentation method was used to obtain a platelet-rich plasma. The best results were obtained if a two-step dilution was carried out with a first dilution in 10% EDTA and a second in 2.5 mM cocaine in water. Using this method the precision study indicated a coefficient of variation of 3.11%. Close agreement was obtained between platelet counts on the Celloscope 401 when compared with the results obtained either by phase-contrast microscopy or using another electronic counter. Allowing for predilution and duplicate counts on each sample, the rate of throughput was approximately 32 samples per hour. Throughout the test period, the instrument remained electronically and mechanically stable.