Factors associated with the route of birth delivery in a city in the Northeast region in the State of Rio Grande do Sul, Brazil / Fatores associados à via de parto em um município da região nordeste do Estado do Rio Grande do Sul, Brasil

Abstract Objectives: to investigate factors associated with the route of birth delivery in a hospital extending public and private healthcare services, in the Northeast region in the State of Rio Grande do Sul. Methods: a cross-sectional study with 676 postpartum women, conducted from January to May 2017. The data were collected from the hospital records and women were interviewed shortly after childbirth in the maternity. Data analysis was performed by associating the Pearson's chi-square and the Poisson regression tests with robust variance. Results: the prevalence of cesarean sections was 58.7%, that is, 41.7% in public health-care and 83.9% in private healthcare. The main reason for having a cesarean section was having had a previous one (PR=5.69; CI95%=3.64 - 8.90; p<0.001), followed by having source of childbirth financing (PR=1.54; CI95%=1.27 - 1.87; p<0.001), having source of prenatal care financing (PR=1.48; CI95%=1.22 - 1.79; p<0.001), the childbirth and prenatal care professional (PR=1.46; CI95%=1.28 - 1.66; p<0.001) and the prenatal care professional (PR=1.43; CI95%=1.07 - 1.90; p=0.016). Conclusions: the high cesarean section rates identified in this study were mainly associated with previous cesarean section. The findings suggest a change in the current childbirth care model in the city, characterized as highly medicalized, focused on the physician and on hospital care.

Resumo Objetivos: investigar os fatores associados à via de nascimento em um hospital de atendimento misto, público e privado, da região nordeste do Rio Grande do Sul. Métodos: estudo transversal com 676 puérperas realizado entre janeiro e maio de 2017. Os dados foram obtidos de registros hospitalares e entrevistas com as mulheres logo após o parto na maternidade. A análise dos dados foi realizada por intermédio do teste de associação do Qui-quadrado de Pearson e Regressão de Poisson com variância robusta. Resultados: a prevalência de cesariana foi de 58,7%, sendo 41,7% no setor público e 83,9%, no privado. Cesárea prévia foi o principal fator associado à realização de cesariana (RP=5,69; IC95%=3,64-8,90; p<0,001), seguido por fonte de financiamento do parto (RP=1,54; IC95%=1,27-1,87; p<0,001), fonte de financiamento do pré-natal (RP=1,48; IC95%=1,22-1,79; p<0,001), profissional do pré-natal e parto (RP=1,46; IC95%=1,28 - 1,66; p<0,001) e profissional do pré-natal (RP=1,43; IC95%=1,07-1,90; p=0,016). Conclusões: as elevadas taxas de cesariana identificadas neste estudo foram associadas principalmente à realização de cesárea prévia. Os achados indicam a necessidade de mudança no modelo de assistência ao parto no município, o qual é altamente medicalizado, centrado no profissional médico e na atenção hospitalar.

Influence of Supplementary Vitamin D on Bone Mineral Density When Used in Combination with Selective Estrogen Receptor Modulators

OBJECTIVES: Vitamin D is regarded as one of the major nutrients that significantly influence bone metabolism. This study aims to look at the effect of supplementary vitamin D on bone mineral density (BMD) in female osteoporosis patients. METHODS: The retrospective hospital record review was performed on 282 patients who were diagnosed with osteoporosis and treated with selective estrogen receptor modulators (SERMs) between January 2015 and December 2016. Of these patients, 151 were treated with SERMs only while 131 were treated using both SERMs and vitamin D supplements. The BMD and any occurrence of osteoporotic fracture episode were investigated after one year. The result of two groups was compared to find the significance of vitamin D. RESULTS: Overall, improvement in BMD score was observed in 76% of the patients. The BMD of the SERMs only group improved by 3% in spine and 1% in the hip while that of the SERMs with vitamin D group improved by 6% and 1% respectively. Statistical significance was noticed in the spine only. One distal radius fracture and one single level vertebral fracture occurred in patients of SERMs group while two distal radius fractures occurred in SERMs with vitamin D group. There was no occurrence of around hip fracture in both groups. CONCLUSION: The result of the current study suggests that additional vitamin D may have some additive effect on improving BMD of the spine. Further study with the larger study population and the extended study period is recommended.

Integrated care among healthcare providers in shared maternity care: what is the role of paper and electronic health records?

This study examines a paper hand-held record and a shared electronic health record in an Australian tertiary hospital healthcare maternity setting and the role that both types of records play in facilitating integrated care among healthcare providers. A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital healthcare providers. In total, 32 interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Three key themes were identified: (1) selective use of records; (2) records as communication of care; and (3) negativity about the use of records. This study demonstrates that healthcare providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care.

Pharmacotherapy follow-up of patients under treatment with biologic agents for chronic inflammatory systemic conditions: an agreement among hospital pharmacists for the standardized collection of a minimum set of data / Seguimiento farmacoterapéutico en pacientes en tratamiento con agentes biológicos por enfermedades sistémicas inflamatorias crónicas: acuerdo entre farmacéuticos hospitalarios para la recopilación estandarizada de un conjunto mínimo de datos

Background and objective: The objective of this study was to reach a consensus on the minimum set of data that would allow to optimize the pharmacotherapy follow-up of patients on biologic agents for chronic systemic inflammatory conditions, through structured and standardized collection with an electronic tool in the hospital pharmacy. Materials and method: A scientific committee was formed (n = 5 hospital pharmacists). The Delphi Technique was used, 2 rounds of consultation by e-mail for hospital pharmacists. A structured questionnaire was used, based on a bibliographic review and recommendations by the scientific committee; 37 statements were assessed with the Likert 5-point scale (1= ‘Strongly Disagree’; 5= ‘Strongly Agree’). Consensus was reached when 75% or more of panel members assigned a score of 1-2 (rejection consensus) or 4-5 (agreement consensus) to the matter reviewed. Descriptive statistical analyses were conducted. Results: The study included 21 hospital pharmacists (70 were invited, there was 70% response). Consensus was reached for 100% of statements. The minimum set of data was agreed upon, as well as the recommendations that the pharmacist had to collect and make during visits: to document the health status, health-related quality of life, changes in treatment compliance and in patient autonomy, as well as the conditions to make feasible the systematic collection of the minimum data set. Conclusions: There is consensus among hospital pharmacists about a minimum data set to be collected, through an electronic tool, which will order, standardize and structure the pharmacotherapy follow-up of patients with chronic inflammatory conditions on treatment with biologic agents in the spanish public health system (AU)

Fundamento y objetivo: El objetivo de este estudio fue consensuar un conjunto mínimo de datos cuya recopilación sistemá- tica y estandarizada, mediante una herramienta electrónica en la farmacia hospitalaria, permitiera optimizar el seguimiento farmacoterapéutico de los pacientes tratados con agentes biológicos por enfermedades sistémicas inflamatorias crónicas. Material y método: Se constituyó un comité científico (n = 5 farmacéuticos hospitalarios). Se empleó la técnica Delphi, 2 rondas de consulta, por correo electrónico entre farmacéuticos hospitalarios. Se utilizó un cuestionario estructurado basado en una revisión bibliográfica y en recomendaciones del comité científico, valorándose 37 afirmaciones en una escala Likert de 5 puntos (1 = ‘En total desacuerdo’; 5 = ‘Totalmente de acuerdo’). Se alcanzó consenso cuando el 75% o más de los panelistas puntuaron 1-2 (consenso-rechazo) o 4-5 (consenso-acuerdo) la cuestión planteada. Se realizaron análisis estadísticos descriptivos. Resultados: Participaron 21 farmacéuticos hospitalarios (70 invitados, 70% respuesta). Se logró consenso en el 100% de las afirmaciones. Se acordó el conjunto mínimo de datos y de recomendaciones que el farmacéutico debe recoger y hacer en las visitas; documentar el estado de salud, la calidad de vida relacionada con la salud, los cambios en la adherencia al tratamiento y en la autonomía de los pacientes, así como las condiciones para hacer factible la recopilación sistemática del conjunto mínimo de datos. Conclusiones: Existe consenso entre los farmacéuticos hospitalarios en un conjunto mínimo de datos cuya recopilación, mediante una herramienta electrónica, ordenará, estandarizará y sistematizará el seguimiento farmacoterapéutico de los pacientes con enfermedades inflamatorias crónicas en tratamiento con agentes biológicos en el entorno sanitario público español (AU)

Malariablood in the pocket. / Malariablut in der Westentasche.

For the first time on June 5, 1919, at the Hamburg State Hospital Friedrichsberg, two paralytics were artificially infected with malaria, subjecting them to the new malaria fever treatment according to Wagner-Jauregg (1917). This article examines the life stories and medical histories of these patients, an opera singer and a yardmaster, and provides an interpretation based on their medical files. Relevant contemporary medical publications contextualise the specific configurations of their hospital stay. In both cases, a detailed comparison between each medical file and the published case history reveals remarkable.discrepancies. A specific concept of remission, mainly determined by the level of restoration of a patient's working power, i. e. the ability to work, was implemented. Finally, the article considers the question of why the new therapy method was introduced in Hamburg specifically on June 5, 1919.

IMPACT OF PRENATAL MATERNAL FACTORS AND BIRTH ORDER ON THE ANTHROPOMETRIC STATUS OF NEWBORNS IN IRAN.

This cross-sectional study was carried out to capture possible maternal factors affecting newborns' anthropometric measurements. Data were collected from eight public health centres and referral university hospital records in Tabriz and Heriss districts, north-west Iran, for 807 mother-neonate pairs delivering live singleton births and their offspring during the two years up to August 2014. The incidence of low birth weight (LBW) was 5.1%. A close correlation was found between maternal anthropometry and birth order with neonatal anthropometric data. Birth order and maternal height and body mass index (BMI) positively affected neonates' birth size (weight, length and head circumference). The rate of LBW was significantly higher for older (≥35 years), taller (≥170 cm), underweight (BMI<18.5) and non-iron-taking women and in the first-born babies. The odds of having LBW newborns in older, taller, underweight, obese and irregular iron-taking women were 3.82, 4.00, 9.07, 3.50 and 2.50 times those of mid-age group, middle-height, overweight and regular iron-taking women, respectively. First-born newborns were 5.97 times more likely to be LBW compared with second-birth neonates. The results indicate that maternal anthropometric indices, age, iron intake and birth order influence the risk of LBW in newborns.

An Autopsy Proven Child Onset Chronic Traumatic Encephalopathy

Here we present an autopsy case of chronic traumatic encephalopathy (CTE) in a 36-year-old man. He had a history of febrile seizures at the age of four and was severely demented at age 10 when he was admitted to a mental hospital. He had suffered repetitive self-harm, such as frequent banging of the head on the wall in his hospital record, but he had no clear history between the ages of four and ten. Autopsy revealed global cerebral atrophy, including the basal ganglia, thalamus, hippocampus, amygdala, mammilary bodies and lateral geniculate bodies. This case showed typical pathological features of CTE. Phosphorylated tau (p-tau)-positive neurofibrillary tangles (NFTs) and neuropil threads (NT) we are widely distributed in the brain, especially in the depth of the cerebral sulci. NFT and NT were also found in the basal ganglia, thalamus, amygdala and brainstem. Scanty β-amyloid deposits were found in the motor and sensory cortices, but α-synuclein was completely negative in the brain. This example showed that CTE can occur in young ages and that even children can experience CTE dementia.

Neonatal Phototherapy and Infantile Cancer.

OBJECTIVE: To determine whether neonatal phototherapy is associated with cancer in the first year after birth. METHODS: We analyzed a data set from the California Office of Statewide Health Planning and Development that was created by linking birth certificates, death certificates, and hospital discharge abstracts up to age 1 year. Subjects were 5 144 849 infants born in California hospitals at ≥35 weeks' gestation from 1998 to 2007. We used International Classification of Diseases, Ninth Revision codes to identify phototherapy at <15 days and discharge diagnoses of cancer at 61 to 365 days. We adjusted for potential confounding variables by using traditional and propensity-adjusted logistic regression models. RESULTS: Cancer was diagnosed in 58/178 017 infants with diagnosis codes for phototherapy and 1042/4 966 832 infants without such codes (32.6/100 000 vs 21.0/100 000; relative risk 1.6; 95% confidence interval [CI], 1.2-2.0, P = .002). In propensity-adjusted analyses, associations were seen between phototherapy and overall cancer (adjusted odds ratio [aOR] 1.4; 95% CI, 1.1-1.9), myeloid leukemia (aOR 2.6; 95% CI, 1.3-5.0), and kidney cancer (aOR 2.5; 95% CI, 1.2-5.1). The marginal propensity-adjusted absolute risk increase for cancer after phototherapy in the total population was 9.4/100 000 (number needed to harm of 10 638). Because of the higher baseline risk of cancer in infants with Down syndrome, the number needed to harm was 1285. CONCLUSIONS: Phototherapy may slightly increase the risk of cancer in infancy, although the absolute risk increase is small. This risk should be considered when making phototherapy treatment decisions, especially for infants with bilirubin levels below current treatment guidelines.

Fatores associados à evolução clínica de mulheres com câncer de mama atendidas em um centro de referência no Rio de Janeiro

A sobrevida em pacientes com câncer de mama tem aumentado nos últimos anos graças aos avanços no tratamento e na detecção precoce da doença. Com isso, desfechos intermediários e competitivos ao óbito pelo câncer de mama se tornaram desfechos importantes, a fim de evitar a piora da qualidade de vida, agravamento da doença e óbito por outras causas. Essa dissertação pretende avaliar a influência de fatores socioeconômicos, clínicos, anatomopatológicos e do tratamento na evolução clínica de mulheres com câncer primário de mama. A população de estudo é formada por pacientes do sexo feminino atendidas em um centro de referência em câncer no Rio de Janeiro no período de janeiro de 2003 a dezembro de 2005. O estudo foi dividido em dois artigos, em que o primeiro avaliou os efeitos dos fatores que se associam às diferentes causas de óbito em mulheres com câncer de mama utilizando modelos de riscos competitivos, e o segundo investigou os fatores associados a cada mudança na evolução clínica de mulheres com câncer de mama utilizando modelo multi-estado. No primeiro artigo foram analisadas 2753 mulheres e como desfechos óbito por câncer de mama e óbito não relacionado à doença. Idade avançada, raça/cor não branca, pior estadiamento e tabagismo foram associados à um maior risco de óbito por câncer de mama, enquanto que apenas a idade avançada foi associada à um maior risco de óbito por causa não relacionado à doença.

O segundo artigo analisou 2709 mulheres em relação à transição entre quatro estados: diagnóstico (s1), ativa/capaz de se cuidar (s2), incapaz de se cuidar (s3) e recidiva/metástase/óbito (s4). Fatores como idade avançada, raça/cor não branca, ausência de histórico familiar de câncer, neoplasias ductais e lobulares, bilateralidade do tumor e receptores hormonais negativos, independentemente do estadiamento clínico, foram associados à piora na capacidade funcional e ao agravamento da doença. Os resultados dessa dissertação evidenciam a importância da avaliação de desfechos intermediários e competitivos ao óbito por câncer de mama nos cuidados com as pacientes, para que sejam traçadas estratégias para aumento de sobrevida e melhora da qualidade de vida.

Survival in patients with breast cancer has increased in recent years due to advances in treatment and early detection of disease. Thus, intermediate and competitive outcomes to death by breast cancer have become important outcomes in order to avoid worsening the quality of life, worsening of disease and death from other causes. This dissertation aims to evaluate the influence of socioeconomic, clinical, pathological and treatment factors on clinical evolution in women with primary breast cancer. The study population consists of female patients with a primary diagnosis of breast cancer treated at a referral center for cancer in Rio de Janeiro enrolled from January 2003 to December 2005. The study was divided into two articles, in which the first evaluated the effects of factors that are associated with different causes of death in women with breast cancer using models of competing risks, and the second investigated the factors associated with each change in clinical evolution of women with breast cancer using multi-state model. In the first article were analyzed 2753 women and outcomes as death from breast cancer and death not related to disease. Older age, race / non-white, worse staging and smoking were associated with a higher risk of death from breast cancer, while only older age was associated with a higher risk of death from causes not related to disease.

The second article examined 2709 women in relation to the transition between four states: diagnosis (s1), active / able to take care of self (s2), unable to care of self (s3) and recurrence / metastasis / death (s4). Factors such as older age, race / non-white, no family history of cancer, ductal and lobular neoplasia, bilateral breast cancer and negative hormone receptor, regardless of clinical stage, were associated with worse Performance Status and the worsening of the disease. The results of this dissertation show the importance of the evaluation of intermediate and competitive outcomes to death from breast cancer in the care of the patients, so that strategies can be traced to increased survival and improved quality of life.

Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among Medicare patients with COPD.

BACKGROUND: COPD is a leading cause of death and disability in the United States. Patients with COPD are at a high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplementation (ONS) has been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. METHODS: Using the Premier Research Database, we first identified Medicare patients aged ≥ 65 years hospitalized with a primary diagnosis of COPD. We then identified hospitalizations in which ONS was provided, and used propensity-score matching to compare LOS, hospitalization cost, and 30-day readmission rates in a one-to-one matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also used instrumental variables analysis to study the association of ONS with study outcomes. Model covariates included patient and provider characteristics and a time trend. RESULTS: Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N = 14,326). In unadjusted comparisons in the matched sample, ONS use was associated with longer LOS (8.7 days vs 6.9 days, P < .0001), higher hospitalization cost ($14,223 vs $9,340, P < .0001), and lower readmission rates (24.8% vs 26.6%, P = .0116). However, in instrumental variables analysis, ONS use was associated with a 1.9-day (21.5%) decrease in LOS, from 8.8 to 6.9 days (P < .01); a hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (P < .01); and a 13.1% decrease in probability of 30-day readmission, from 0.34 to 0.29 (P < .01). CONCLUSIONS: ONS may be associated with reduced LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD.

Preoperative Coronary Stenosis Is a Determinant of Early Vascular Outcome after Carotid Endarterectomy

BACKGROUND AND PURPOSE: The benefit of carotid endarterectomy (CEA) is directly influenced by the risk of perioperative adverse outcomes. However, patient-level risks and predictors including coronary stenosis are rarely evaluated, especially in Asian patients. The aim of this study was to determine the relationship between the vascular risk factors underlying CEA, including coronary stenosis, and postoperative outcome. METHODS: One hundred and fifty-three consecutive CEAs from our hospital records were included in this analysis. All patients underwent coronary computed tomography angiography before CEA. Data were analyzed to determine the vascular outcomes in patients with mild-to-moderate vs. severe coronary stenosis and high vs. standard operative risk, based on the criteria for high operative risk defined in the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial. The vascular outcome was defined as the occurrence of postoperative (< or =30 days) stroke, myocardial infarction (MI), or death. RESULTS: An adverse vascular outcome occurred in 8 of the 153 CEAs, with 6 strokes, 2 MIs, and 3 deaths. The vascular outcome differed significantly between the groups with mild-to-moderate and severe coronary stenosis (p=0.024), but not between the high- and standard-operative-risk groups (stratified according to operative risk as defined in the SAPPHIRE trial). Multivariable analysis adjusting for potent predictors revealed that severe coronary stenosis (odds ratio, 6.87; 95% confidence interval, 1.20-39.22) was a significant predictor of the early vascular outcome. CONCLUSIONS: Severe coronary stenosis was identified herein as an independent predictor of an adverse early vascular outcome.

The relationship between Physical Growth and Major Sources of Serum Vitamin D among Hospitalized Children of Changwon City / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to investigate the effects of the sources of vitamin D (duration of exposure to sunlight, intake of major food sources for vitamin D or vitamin D supplements) on the serum 25-(OH) D3 levels, and the physical growth of a child. METHODS: Subjects were 296 children aged 1 to 5 years who visited S hospital located in Changwon City. Survey data collection was carried out by direct interview method, and the biochemical data were collected using hospital records. RESULTS: The study subjects were divided into three groups according to their levels of serum 25-(OH) D3 (deficient, relatively insufficient, sufficient) and their percentage were 48.3%, 44.3% and 7.4% respectively. The average concentration of serum 25-(OH) D3 was 20.41 +/- 6.55 ng/mL, which was relatively insufficient. The average duration of exposure to sunlight was 58.86 +/- 49.18 minutes/day. A total score of vitamin D major food sources was 46.71 points (full marks 153), and the most frequently consumed food items were milk, eggs, and cheese. Thirty-four percent of the subjects took vitamin D supplements and their dose were 11.96 microg/day. Three vitamin D sources in sufficient group were higher than deficient or relatively insufficient group significantly. Intake of vitamin D supplements showed positive relation (+) and high explanation power (R2= 0.288) on serum 25-(OH) D3 concentration, but intake of vitamin D major food sources (+) and the duration of exposure to sunlight (+) had a low explanation power (R2= 0.068). The relations between serum 25-(OH) D3 concentration and physical growth (height and weight) were shown as negative (??, and their explanation powers were low as 7.3% and 5.9% respectively. CONCLUSIONS: This study results can be useful when discussing the intake standard of vitamin D and the effective intake method for children. In addition, it will be helpful to build the children's nutrition policy and to plan the nutrition education program to improve the vitamin D status in children.

Central Transposition of the Cephalic Vein in Patients with Brachiocephalic Arteriovenous Fistula and Cephalic Arch Stenosis

PURPOSE: Our study aims to evaluate to evaluate clinical outcomes after cephalic vein transposition (CVT) to the axilla in patients with brachiocephalic arteriovenous fistula (BC-AVF) and cephalic arch stenosis (CAS). MATERIALS AND METHODS: Hospital records of 13 patients (median age, 61 years; males, 54%) who received CVT to the proximal basilic/axillary vein due to either dysfunction (n=2) or thrombosis (n=11) between January 2010 and February 2014 were retrospectively reviewed. RESULTS: Operation was performed under local anesthesia in all cases. There was no technical failure. Concomitant inflow procedure (banding or aneurysmorrhaphy) was performed in 5 patients (38%). During follow-up (1 to 50 months, median 17 months), 3 patients died with functioning AVF and one was successfully transplanted. Two patients suffered from recurrent symptomatic stenosis of AVF and received percutaneous balloon angioplasty. Another 2 patients experienced AVF occlusion treated with interposition graft and manual fragmentation. Overall primary, assisted primary, and secondary patency rates were 77.5%, 92.3%, and 100% at 6 months and 66.1%, 92.3%, and 100% at 1 year, respectively. CONCLUSION: Although most patients presented with BC-AVF occlusion, technical success and access patency rates after CVT were favorable compared with historical data for interventional treatment. CVT should be considered as an appropriate option in selected patients with CAS.

Retrospective medical record review of an osteopathic manipulative medicine hospital consultation service.

CONTEXT: In the first half of the 20th century, nearly all osteopathic physicians used osteopathic manipulative medicine (OMM) in the care of hospitalized patients. Over the past few decades, however, inpatient OMM care has declined and is more commonly provided by OMM specialists. OBJECTIVE: To retrospectively evaluate the details of a specialty-level OMM inpatient consultation service. METHODS: Inpatient OMM consultations that took place at Northeast Regional Medical Center in Kirksville, Missouri, between July 1998 and March 2008 were identified from billing records. Consultations were reviewed for demographic information, admission location, postoperative status, intensive care unit and mechanical ventilation usage, admission and discharge diagnoses, consultation reasons and final diagnoses, areas of somatic dysfunction treated and types of osteopathic manipulative treatment (OMT) techniques used, and hospital length of stay (LOS). RESULTS: A total of 1509 OMM consultations were identified (580 for male patients [38%]; 929 for female patients [62%]; mean [SD] age, 54 [31] years [range, 0-99 years]), representing 11% of all inpatient consultations. Of these, 1372 consultations (91%) were initiated in the inpatient acute care facility, 87 (6%) in the inpatient acute rehabilitation facility, and 50 (3%) in the skilled nursing facility. Further, 265 consultations (18%) were for postoperative patients, 187 (12%) were for patients in the intensive care unit, and 54 (4%) were for patients receiving mechanical ventilation at the time of the consultation. The most common admission diagnoses were hypertension, routine newborn care, lower respiratory infection, chronic obstructive pulmonary disease, and gastrointestinal symptoms. The most common reasons for OMM consultation were chest/rib pain, spinal pain, lower respiratory infection (adjunctive treatment), cranial asymmetry, and infant feeding disorder. The most common types of OMT techniques used were myofascial release, balanced ligamentous tension, muscle energy, soft tissue, and inhibition. The mean (SD) LOS was 5.7 (3.3) days (range, 0-48 days), while the mean (SD) number of days the patient received OMT was 3.1 (2.2) days. CONCLUSION: Medical records reviewed in the current study revealed that OMM consultations were ordered primarily for musculoskeletal complaints, respiratory problems (adjunctive treatment), and newborn care. A variety of OMT techniques were used. Further retrospective study is warranted to determine if OMM had an effect on LOS.

Teen birth rates in sexually abused and neglected females.

OBJECTIVE: Prospectively track teen childbirths in maltreated and nonmaltreated females and test the hypothesis that child maltreatment is an independent predictor of subsequent teen childbirth over and above demographic characteristics and other risk factors. METHODS: Nulliparous adolescent females (N = 435) aged 14 to 17 years were assessed annually through age 19 years. Maltreated females were referred by Child Protective Services agencies for having experienced substantiated sexual abuse, physical abuse, or neglect within the preceding 12 months. Comparison females were matched on race, family income, age and family constellation. Teen childbirth was assessed via self-report during annual interviews. Births were confirmed using hospital delivery records. RESULTS: Seventy participants gave birth during the study, 54 in the maltreated group and 16 in the comparison group. Maltreated females were twice as likely to experience teen childbirth after controlling for demographic confounds and known risk factors (odds ratio = 2.17, P = 0.01). Birth rates were highest for sexually abused and neglected females. Sexual abuse and neglect were both independent predictors of teen childbirth after controlling for demographic confounds, other risk factors and alternative forms of maltreatment occurring earlier in development. CONCLUSIONS: Results provide evidence that sexual abuse and neglect are unique predictors of subsequent teen childbirth. Partnerships between protective service providers and teen childbirth prevention strategists hold the best promise for further reducing the US teen birth rate. Additional research illuminating the pathways to teen childbirth for differing forms of maltreatment is needed so that tailored interventions can be realized.

Obstetric fistula in Southern Sudan: situational analysis and Key Informant Method to estimate prevalence.

BACKGROUND: Obstetric fistula is a severe condition which can have devastating consequences for a woman's life. Despite a considerable literature, very little is known about its prevalence. This project was conducted to carry out a situational analysis of fistula services in South Sudan and to pilot test the Key Informant Method (KIM) to estimate the prevalence of fistula in a region of South Sudan. METHODS: Key stakeholder interviews, document reviews and fistula surgery record reviews were undertaken. A KIM survey was conducted in a district of Western Bahr-el-Ghazal in January 2012. One hundred sixty-six community-based distributors, traditional birth attendants and village midwives were trained as key informants to identify women with fistula in the community. Women identified were subsequently examined by an obstetrician and nurse to verify whether they had a fistula. RESULTS: There were limited fistula repair services in South Sudan. Approximately 50-80 women per year attend periodic campaigns, with around half having a fistula and receiving a repair. On average a further 5 women a year received fistula repair from hospital services. Ten women with potential fistula were identified via KIM; all confirmed by the obstetrician. Of these, three were from the survey area, which had 8,865 women of reproductive age (15-49 years). This gives a minimal estimated prevalence of at least 30 fistulas per 100,000 women of reproductive age (95% CI 10-100). CONCLUSIONS: Routine fistula repair services available do not meet the population's needs. The pilot study suggests that KIM can be used to identify women with fistula in the community. Data on fistula are generally poor; the KIM methodology we used in South Sudan yielded a lower fistula prevalence than estimates reported previously in the region.

Survey of practices and policies relating to the use of complementary and alternative medicines and therapies in New South Wales cancer services.

AIMS: To examine policies and practices relating to the provision, prescription and monitoring of complementary and alternative medicine and therapies (CAM) in conventional cancer services in NSW. METHODS: Self-administered questionnaire sent to directors of all 65 eligible cancer services in NSW in 2009. RESULTS: Forty-three services responded to the survey (response rate 66%). Only six (14%) services reported having formal policies about CAM. Most (n = 33, 77%) expected that patients would be asked about CAM use during their initial assessment. Eight services (19%) provided and/or prescribed CAM for patients, and most of these (n = 7) recorded details of CAM use in patients' records. Only four (9%) services permitted CAM practitioners from the community to attend inpatients, whereas 24 (56%) permitted inpatients to bring in their own CAM. Most of these services (n = 17) required medical approval for the use of CAM. Of the latter, most (n = 13) recorded the use of approved CAM, but only seven recorded use of unapproved CAM and only three refused permission to continue use of unapproved CAM. CONCLUSION: Most cancer services in NSW recognise potential CAM use by patients and expect medical staff to ask patients about their use of CAM. While few cancer services provided or prescribed CAM, over half permitted inpatients to bring their own CAM into hospital. There was little control over the use of CAM, however, and monitoring was lax. Given the wide usage of CAM by patients with cancer, this lack of control may compromise clinical outcomes, with potentially dangerous consequences.

Defining care products to finance health care in the Netherlands.

A case-mix project started in the Netherlands with the primary goal to define a complete set of health care products for hospitals. The definition of the product structure was completed 4 years later. The results are currently being used for billing purposes. This paper focuses on the methodology and techniques that were developed and applied in order to define the casemix product structure. The central research question was how to develop a manageable product structure, i.e., a limited set of hospital products, with acceptable cost homogeneity. For this purpose, a data warehouse with approximately 1.5 million patient records from 27 hospitals was build up over a period of 3 years. The data associated with each patient consist of a large number of a priori independent parameters describing the resource utilization in different stages of the treatment process, e.g., activities in the operating theatre, the lab and the radiology department. Because of the complexity of the database, it was necessary to apply advanced data analysis techniques. The full analyses process that starts from the database and ends up with a product definition consists of four basic analyses steps. Each of these steps has revealed interesting insights. This paper describes each step in some detail and presents the major results of each step. The result consists of 687 product groups for 24 medical specialties used for billing purposes.

Safety and efficacy of milk and molasses enemas compared with sodium phosphate enemas for the treatment of constipation in a pediatric emergency department.

OBJECTIVES: The purpose of this study was to determine the safety and efficacy of routine milk and molasses enemas (MME) compared with sodium phosphate enemas for the treatment of constipation in the pediatric emergency department (ED). A secondary objective included the identification of factors associated with enema selection in the pediatric ED. METHODS: This study was approved by the University of Texas Southwestern Medical Center Institutional Review Board. The study design was a retrospective comparative chart review. Medical records of patients who presented to the ED and received either MME or sodium phosphate enema for constipation between November 1, 2007, and November 1, 2008, were identified and reviewed for data collection. The following data were collected to determine safety and efficacy: baseline demographics, chief complaint, medical history, radiographic imaging, enema type, treatment dose, adverse effects, improvement in symptoms, time until defecation, failure of initial therapy requiring additional intervention, and time from treatment until disposition. RESULTS: Both treatment groups had similar baseline characteristics. No statistically significant differences in treatment effect were noted between MME and sodium phosphate enemas. Several clinically significant trends were noted including the need for additional rectal treatment after administration of sodium phosphate enemas versus oral therapy after MME. In addition, there were 6 cases of treatment failure with sodium phosphate enemas versus 1 case with MME. CONCLUSIONS: No statistically significant differences were found between MME and sodium phosphate enemas. Based on our results, the 2 treatment options were found to be equally safe and effective.