ABSTRACT
BACKGROUND: Timely identification of esophageal atresia is challenging. Diagnosis may be suspected antenatally with a combination of polyhydramnios, associated with a small or absent stomach bubble or other anomalies. Esophageal atresia can be suspected postnatally in the presence of tachypnea, increased oral secretions, and an inability to advance an orogastric tube. Failure to recognize an esophageal atresia can have life-threatening implications. CLINICAL FINDINGS: A 5-day-old infant with a history of failure to thrive and respiratory distress presented in a community emergency department following a prolonged apnea associated with a breastfeed. PRIMARY DIAGNOSIS: Delayed postnatal diagnosis of esophageal atresia and tracheoesophageal fistula. INTERVENTIONS: During stabilization in the emergency department, a nasogastric tube was placed to decompress the stomach. A subsequent chest and abdominal radiograph identified the nasogastric tube curled in the upper esophagus, confirming an esophageal atresia. The abdominal radiograph demonstrated gaseous distension, suggesting the presence of a distal tracheoesophageal fistula. OUTCOMES: The neonate had a primary esophageal anastomosis and fistula ligation in a surgical neonatal unit. He was discharged home at 29 days of life. PRACTICE RECOMMENDATIONS: Understanding the challenges of an antenatal diagnosis and awareness of postnatal presentation with a view to improving postnatal recognition and better-quality outcomes for infants with an esophageal atresia and tracheoesophageal fistula.
Subject(s)
Esophageal Atresia , Tracheoesophageal Fistula , Delayed Diagnosis , Esophageal Atresia/diagnosis , Esophageal Atresia/surgery , Female , Humans , Infant, Newborn , Ligation , Male , Pregnancy , Prenatal Diagnosis , Tracheoesophageal Fistula/diagnosis , Tracheoesophageal Fistula/surgerySubject(s)
Anemia, Dyserythropoietic, Congenital/complications , Ferritins/blood , Humans , Male , Middle AgedSubject(s)
Animal Welfare , Dogs/surgery , Ear/surgery , Tail/surgery , Animals , Animals, Newborn , Breeding , Ethics, Professional , Pain/prevention & control , Pain/veterinarySubject(s)
Environmental Health , Global Health , Greenhouse Effect , Health Planning Guidelines , Health Services Needs and Demand/organization & administration , Advisory Committees , Disasters , Emigration and Immigration , Food Supply , Forecasting , Health Policy , Health Status Disparities , Housing , Humans , Morbidity , Mortality , Poverty , Public Health , Sanitation , Water SupplyABSTRACT
AIM: Workplace bullying is a growing concern amongst health professionals. Our aim was to explore the frequency, nature, and extent of workplace bullying in an Auckland Hospital (Auckland, New Zealand). METHOD: A cross-sectional questionnaire survey of house officers and registrars at a tertiary hospital was conducted. RESULTS: There was an overall response rate of 33% (123/373). 50% of responders reported experiencing at least one episode of bullying behaviour. The largest source of workplace bullying was consultants and nurses in equal frequency. The most common bullying behaviour was unjustified criticism. Only 18% of respondents had made a formal complaint. CONCLUSION: Workplace bullying is a significant issue with junior doctors. We recommend education about unacceptable behaviours and the development of improved complaint processes.
Subject(s)
Interprofessional Relations , Medical Staff, Hospital/psychology , Scapegoating , Stress, Psychological/etiology , Adult , Cross-Sectional Studies , Female , Hospitals, Teaching , Humans , Male , Medical Staff, Hospital/classification , New Zealand/epidemiology , Prevalence , Stress, Psychological/epidemiology , Stress, Psychological/psychology , Surveys and QuestionnairesABSTRACT
Mecsas and colleagues suggest that a deficiency in the chemokine receptor CCR5 in humans is unlikely to confer protection against plague, based on their study of Yersinia pestis infection in Ccr5-deficient mice. They were testing the hypothesis that a mutation in the CCR5 gene, frequently found in Caucasians, may have been selected for in the past because it provided protection against (bubonic) plague; the mutation, called CCR5Delta32, is characterized by a 32-base-pair deletion. We have also tested this hypothesis by using Y. pestis infection in mice and, in addition, we have done phagocytosis experiments with macrophages from wild-type and Ccr5-deficient mice. Although, like Mecsas et al., we did not see any difference in the survival of the two groups of mice, we did find that there was a significantly reduced uptake of Y. pestis by Ccr5-deficient macrophages in vitro. Our results indicate that the role of Ccr5 in Y. pestis infection may therefore be more complex than previously thought.
Subject(s)
Evolution, Molecular , Plague/genetics , Plague/metabolism , Receptors, CCR5/genetics , Receptors, CCR5/metabolism , Animals , Humans , Macrophages/cytology , Macrophages/immunology , Macrophages/metabolism , Macrophages/microbiology , Mice , Mice, Inbred BALB C , Mice, Inbred C57BL , Models, Biological , Phagocytosis , Plague/microbiology , Receptors, CCR5/deficiency , Sequence Deletion/genetics , Survival Rate , Virulence , White People/genetics , Yersinia pestis/pathogenicity , Yersinia pestis/physiologyABSTRACT
Children's participation in physical activity is declining, and nowhere is this more apparent than in the incidental activity of walking to school. The aim of this pilot study was to examine the extent to which Australian children walked to and from primary school, and to survey parents to identify factors influencing this behaviour. Parents of 164 students in Grades 1 7 (mean age 9.1 +/- 2.02 years) from a primary school comprising 360 students responded to a questionnaire regarding psychosocial and environmental factors thought to influence the means by which their children went to and from school. Results indicated that parent perception of the importance of physical activity, parents' individual history of transport to school as well as distance from school were the most statistically significant factors determining children's involvement in walking to and from school. The results of this study highlight the attitudes and experiences of parents in determining the extent to which children are involved in non-motorized access to school. Also implicated are organizational policies about geographical school regions. While this study is limited to one school community, further study is recommended with others to better confirm findings by examining socioeconomic, geographic and policy variables. Occupational therapists are challenged to examine ways in which incidental physical activity can be increased in the lives of young children.