Outcomes of Laparoscopic Gastric Greater Curvature Plication in Morbidly Obese Patients.

BACKGROUND: Laparoscopic gastric greater curvature plication (LGGCP) is a restrictive bariatric procedure without gastrectomy. However, limited literature on effectiveness of gastric plication exists. OBJECTIVES: We assessed LGGCP's efficacy, effects on associated comorbidities, safety and the rate of complications, and patient satisfaction with LGGCP's outcomes among morbidly obese patients. METHOD: Analysis of retrospectively data collected from medical records of 26 patients who had undergone LGGCP at Hamad General Hospital, Qatar, during 2011-2012. RESULTS: Most patients (92%) were Qatari nationals. The sample's mean age was 35.1 years. Mean duration of hospital stay was 3.9 ± 1.2 days. Mean preoperative BMI was 40.7 kg/m2 that decreased at 2 years to 34.6 kg/m2. LGGCP's effects on comorbidities were such that 7.6% of patients experienced resolutions of their comorbidities. There were no mortality or postoperative complications that required reoperation. Six patients (23%) were satisfied with the LGGCP's outcomes while 10 patients (38.5%) underwent sleeve gastrectomy subsequently. CONCLUSION: LGGCP had acceptable short term weight loss results, exhibited almost no postoperative complications, and improved patients' comorbidities. Despite the durability of the gastric fold, some patients regained weight. Future research may assess the possibility of an increase in the gastric pouch size postplication associated with weight regain.

Testosterone therapy has positive effects on anthropometric measures, metabolic syndrome components (obesity, lipid profile, Diabetes Mellitus control), blood indices, liver enzymes, and prostate health indicators in elderly hypogonadal men.

To alleviate late-onset hypogonadism, testosterone treatment is offered to suitable patients. Although testosterone treatment is commonly given to late-onset hypogonadism patients, there remains uncertainty about the metabolic effects during follow-ups. We assessed the associations between testosterone treatment and wide range of characteristics that included hormonal, anthropometric, biochemical features. Patients received intramuscular 1,000 mg testosterone undecanoate for 1 year. Patient anthropometric measurements were undertaken at baseline and at each visit, and blood samples were drawn at each visit, prior to the next testosterone undecanoate. Eighty-eight patients (51.1 ± 13.0 years) completed the follow-up period. Testosterone treatment was associated with significant increase in serum testosterone levels and significant stepladder decrease in body mass index, total cholesterol, triglycerides and glycated haemoglobin from baseline values among all patients. There was no significant increase in liver enzymes. There was an increase in haemoglobin and haematocrit, as well as in prostate-specific antigen and prostate volume, but no prostate biopsy intervention was needed for study patients during 1-year testosterone treatment follow-up. Testosterone treatment with long-acting testosterone undecanoate improved the constituents of metabolic syndrome and improved glycated haemoglobin in a stepladder fashion, with no adverse effects.

Is the daily use of vacuum erection device for a month before penile prosthesis implantation beneficial? a randomized controlled trial.

Patient concerns about penile length after penile prosthesis (PP) implantation for erectile dysfunction (ED) have significant impact on patients and their partners. In addition, corporal fibrosis is associated with difficult PP implantation. The preoperative use of vacuum erectile devices (VED) is an uncommon physical treatment for such concerns. Therefore, the current randomized controlled study assessed two outcomes: whether pre-operative VED use for a month before surgery would significantly increase flaccid stretched penile length (SPL) on the day of surgery, and facilitate easier corporal dilatation intraoperatively. Fifty-one patients scheduled for PP implantation for ED were randomized to either intervention group (pre-operative VED use; 10-15 min/day for ≥30 days; Group A; n = 25), or control group (no intervention; Group B; n = 26). A research assistant (blinded to the treatment assignments) recorded SPL at baseline (initial consultation) and on day of surgery. The surgeons performing the PP implantation (also blinded to the treatment assignments) provided subjective assessments of the ease of corporal dilatation. Baseline patient characteristics, demographics, and comorbidities were the same in both groups. Baseline measurements (SPL-1) were 10.71 ± 1.28 and 10.87 ± 1.26 cm in Group A and Group B, respectively; and the day of surgery measurements (SPL-2) were 11.50 ± 1.33 and 11.06 ± 1.34 cm in Group A and Group B, respectively. In terms of outcomes: mean SPL increase in Group A was significantly more by a mean of 0.80 ± 0.38 cm (p < 0.05) compared to Group B; and surgeons' subjective report of surgical ease indicated smoother corporal dilatation for Group A compared to Group B. VED use (10-15 min/day during the month prior to PP implantation) was associated with significantly increased SPL on day of surgery, and facilitated easier corporal dilatation intraoperatively. Future studies should examine the long-term outcomes of penile prosthesis implantation after pre-operative use of vacuum erectile devices.

Occupational Safety Precautions among Nurses at Four Hospitals, Nablus District, Palestine.

Occupational hazards, exposure to blood and body fluids (BBF) accidents and safety precautions constitute an important public health issue. We assessed the prevalence and determinants of exposure to occupational hazards among nurses, and their knowledge of occupational safety precautions. In a cross-sectional study, we surveyed 332 nurses working in 4 hospitals, Nablus, West Bank, Palestine, by a questionnaire. Bivariate analysis tested the associations between ever exposure and the high likelihood of BBF exposure and the independent socio-demographic and occupational variables. Binary logistic regression analysis was used to assess the associations between the same two exposures and selected independent variables (those significant in the bivariate analysis). Prevalence of ever exposure to BBF was 51.7%, and was associated with working in private and charitable hospitals (OR 2.62, 2.68, respectively), having 4-6 family members (OR 0.52) and "nursing" being as one's top career choice at university (OR 0.48). The prevalence of high likelihood of BBF exposure was 62.2%, and was associated with working in charitable and private hospitals (OR 7.81, 2.43, respectively) and "nursing" being as one's top career choice (OR 0.57). Regarding knowledge, most respondents believed it is necessary to enact laws and regulations regarding occupational safety precautions, reported the use of sharps containers, immediate disinfection after an accident, reporting an accident, and using personal protective equipment. Nurses had adequate knowledge of the risks of their hospital work. Nevertheless, they exhibited high prevalence of exposure to BBF accidents. Future studies are needed to re-evaluate existing occupational safety guidelines in hospitals, establish monitoring and evaluation protocols for health care workers' adherence to the guidelines, and institute well-defined policies for reporting occupational injury incidents so these can be handled appropriately.

Case study of cognitive behavioural therapy awareness educational programme using blended learning, UK.

This paper examined the opportunities as well as challenges in relation to the use of cognitive behavioural therapy (CBT). The opportunities include the increased range of mental health conditions and other disorders where CBT (in isolation or with other interventions) could be effective to address them, as well as policies around workforce education and training that support the expansion of psychological therapies, particularly CBT services. The challenges include the urgent need of heightened awareness among the wider platform of health and social care workers about CBT principles, structure, framework, methods of delivery, wider applications, evaluation and appropriate referral of clients, and stepped model of care. In response to such needs, the paper described CBT awareness educational award at the University of Gloucestershire, UK: the Certificate of Professional Studies in Awareness of Cognitive and Behavioural Therapies Practice delivered at Level III and M level. The challenges associated with the initiation and running of such educational programmes are highlighted, as well as suggestions for the way forward considering the learners', employers' and educational providers' perspectives.

Have neonatal mortality rates in the state of Qatar become static? A PEARL study analysis.

To ascertain the national neonatal mortality rate in Qatar during the first quarter of 2011 (1 January-31 March), we carried out a prospective pilot national epidemiologic study. Nationwide birth and neonatal mortality data were collected using predesigned, structured questionnaires. To analyse trends over the previous 4 years (2008-2011) we used neonatal mortality data for 2008-2010 from the database of the neonatal unit at the Women's Hospital, annual reports of Hamad Medical Corporation, and published neonatal mortality data for 2010 for comparative analysis. A total of 4909 live births and 21 neonatal deaths were recorded during the study period. The neonatal mortality rate was 4.28/1000 live births (corrected neonatal mortality rate 2.85/1000). The early neonatal mortality rate was 1.84/1000 and the late neonatal mortality rate was 2.44/1000 live births. Fifteen of the 21 neonatal deaths were in non-Qatari babies, reflecting the ethnic distribution in the population. Neonatal mortality rates in Qatar declined very little between 2008 and the first quarter of 2011.

Have neonatal mortality rates in the state of Qatar become static? A PEARL study analysis

To ascertain the national neonatal mortality rate in Qatar during the first quarter of 2011 [1 January-31 March], we carried out a prospective pilot national epidemiologic study. Nationwide birth and neonatal mortality data were collected using predesigned, structured questionnaires. To analyse trends over the previous 4 years [2008-2011] we used neonatal mortality data for 2008-2010 from the database of the neonatal unit at the Women's Hospital, annual reports of Hamad Medical Corporation, and published neonatal mortality data for 2010 for comparative analysis. A total of 4909 live births and 21 neonatal deaths were recorded during the study period. The neonatal mortality rate was 4.28 /1000 live births [corrected neonatal mortality rate 2.85 /1000]. The early neonatal mortality rate was 1.84 /1000 and the late neonatal mortality rate was 2.44/1000 live births. Fifteen of the 21 neonatal deaths were in non-Qatari babies, reflecting the ethnic distribution in the population. Neonatal mortality rates in Qatar declined very little between 2008 and the first quarter of 2011

The place and promotion of well-being in mental health services: a qualitative investigation.

The study investigated the place and promotion of well-being from the perspectives of services users and mental health professionals. * Data from focus groups and interviews were analysed and found that well-being promotion was available, for example weight management groups in mental health services. However, they also found that there were some contradictions between the groups of people interviewed about what was available and what to promote in the future. * The study concludes suggesting partnerships with local communities to further develop well-being services, such as opportunities for physical activity, for people with mental health problems. Abstract This study explored service users' and mental health professionals' understandings, experiences and opinions of well-being and its promotion within mental health services. A qualitative case study methodology included nine participants (five adult service users, three mental health professionals, one senior manager) who were purposively sampled from a Mental Health Trust in England. Service users participated in a focus group, while individual semi-structured interviews were held with the mental health professionals and senior manager. Interpretative phenomenological analysis of the data revealed five main themes including well-being as a holistic concept; well-being promotion; the place, promotion and position of well-being; role of mental health services in well-being promotion; and areas for further improvement. Findings revealed evidence of well-being promotion; however, there were contradictions regarding what was known between the groups of participants and what could be provided in the future. Implications for practice include the need to establish more effective partnership working between mental health services and local communities, especially in light of financial constraints within health services at large. This could assist the increased provision of therapeutic services for well-being promotion.

Changes in physical activity in pre-schoolers and first-grade children: longitudinal study in the Czech Republic.

BACKGROUND: The transition from kindergarten to first year at school is associated with a variety of psychosocial changes in children. The aim of this longitudinal study was to identify the changes in children's physical activity (PA) upon entry to first year at school; and to identify the days of the school week that exhibit low PA. METHODS: We monitored the PA levels of 176 children twice: initially in kindergarten and again in first-year classes at school. The age (mean +/- standard deviation) of children at kindergarten was 5.7 +/- 0.5 years and 6.7 +/- 0.5 years at the first year of elementary school. We evaluated PA employing the activity energy expenditure (AEE - kcal/kg/day) from Caltrac accelerometer and daily amount of steps (STEPS) from Yamax pedometer. Participants were monitored over 7 days to include a weekend. RESULTS: The mean AEE was 11.5 in pre-school girls and 12.9 kcal/kg/day in boys; and STEPS were 9923 steps/day in girls and 11 864 in boys on weekdays. At weekends, it was 11.5 kcal/kg/day in girls and 12.7 kcal/kg/day in boys and 10 606 steps/day in girls and 11 182 steps/day in boys. The mean AEE and STEPS in first-grade girls and boys was 9.9 and 9.8 kcal/kg/day respectively, and 7911 and 8252 steps/day respectively on weekdays, and 8.8 and 9.0 kcal/kg/day and 6872 and 7194 steps/day respectively at weekends. First-grade school children had significantly lower PA than pre-school children on weekdays (P < 0.0001) and at weekends (P < 0.0001). Decline in PA on weekdays was during time spent at school (P < 0.0001) and not during after-school children's leisure time. CONCLUSION: The parts of the week when first-grade school children show low PA are the times spent in lessons and in after-school nursery and at weekends. PA needs to be promoted using intervention programmes mainly during the after-school nursery programmes and at weekends.

Alcohol consumption and attitudes towards banning alcohol sales on campus among European university students.

OBJECTIVES: The European Commission's new health strategy for improving health at the European Union (EU) level includes tackling alcohol consumption. This study aimed to assess the prevalence of alcohol consumption and problem drinking, as well as students' attitudes towards banning the sale of alcohol on campus. STUDY DESIGN: In total, 5826 students from universities in seven European countries (Denmark, Germany, Spain, Lithuania, Poland, Bulgaria and Turkey) took part in this cross-sectional study. METHODS: A self-administered questionnaire assessed sociodemographic information, frequency of alcohol consumption, problem drinking and attitudes towards banning the sale of alcohol on campus. RESULTS: The highest prevalence of drinking alcohol more than once per week was reported in Bulgarian (males 46%, females 64%) and Spanish students (males 59%, females 64%). Among those students who drank alcohol (n=3170), problem drinking (CAGE score >1) was found in 24% of males and 13% of females. Male gender, depressive moods and a low importance of good grades at university were risk factors for drinking alcohol more than once per week as well as for problem drinking. There were substantial country differences in the proportion of students who would support a ban of alcohol sales on campus (23% in Denmark, 88% in Poland). Support for a ban was higher among female students and among students who drank alcohol once or less per week. CONCLUSIONS: Problem drinking is a concern among students in many European countries, especially among males. Students' support for banning the sale of alcohol on campus varies between countries and should be considered in developing EU policy.

Students' satisfaction with their health and social care educational programmes: qualitative findings from the UK.

This article reports a qualitative assessment of students' satisfaction with their health and social care educational programmes. The responses of 66 students who completed an open-ended "comments" section at the end of a survey to assess students' satisfaction were coded and analysed using the constant comparative method. Respondents commented on: course organization, module organization, workload, module content, course delivery, personnel delivering modules, course workload and assessment, and resources available. The findings suggest that 3 interrelated factors are imperative for "educationally effective" modules: 1) module administration, content and assessment; 2) module teams and university resources; and 3) module relevance.

Students' satisfaction with their health and social care educational programmes: qualitative findings from the UK

This article reports a qualitative assessment of students' satisfaction with their health and social care educational programmes. The responses of 66 students who completed an open-ended "comments" section at the end of a survey to assess students' satisfaction were coded and analysed using the constant comparative method. Respondents commented on: course organization, module organization, workload, module content, course delivery, personnel delivering modules, course workload and assessment, and resources available. The findings suggest that 3 interrelated factors are imperative for "educationally effective" modules: 1] module administration, content and assessment; 2] module teams and university resources; and 3] module relevance

What matters most? Predictors of student satisfaction in public health educational courses.

The development of primary care trusts, the health protection agency, and non-medical public health (PH) specialists' pathways requires a competent PH workforce to be in place. Hence, the quality of education and training of PH workers is increasingly critical. With the diversity of courses and programmes that contribute to building a competent PH workforce, few studies have examined the satisfaction of students (and reasons for it) on educational PH programmes. The present study investigated the influences that four demographic variables (gender, disability, ethnicity and age bracket) and seven education-related variables (mode of study, academic term, academic level, pre-/postregistration status, entry qualification, qualification aim and class size) have on PH students' perceptions of satisfaction with 18 aspects of their learning. After controlling for the effects of the other variables, five variables explained 32% of the reported satisfaction levels. These were class size, study mode, qualification aim, pre-/postregistration status and academic level. Part-time students on postgraduate programmes are a particularly vulnerable group who may need extra support from PH educators and trainers. For these students, smaller class sizes could be beneficial, and if larger classes are inevitable, smaller group work sessions within the classes is advocated. Equally important is the availability of library resources required for learning, and course materials, handbooks and briefs need to be clear, informative, user friendly and available early in the course. Satisfied students achieved better final grades, reflecting an increased amount of transferable knowledge. The implications of the study findings for research and practice are discussed.

Collaborative research partnerships with disadvantaged communities: challenges and potential solutions.

Community/campus research collaborations face multiple challenges. An understanding of the community's background, history, habits and traditions, values and mode of operations is required. This article narrates a 3-year experience of undertaking collaborative public health research with five disadvantaged communities in various provinces of South Africa. Based on the experience, five main challenges exist: the value systems of those collaborating in the research; the stakeholders' costs and benefits of being involved; issues of empowerment and capacity transfer; the need for multidisciplinary research approaches; and the prerequisite of the clarity of relationships and roles between researcher and community. Categorized under the five main challenges are examples of 19 interlacing 'concepts' that detailed the South African research partnership from the perspective of the processes, dealings and daily difficulties. Examples of the challenges and concepts are highlighted from the author's research experiences with disadvantaged communities. These challenges increase exponentially with the inclusion of more research sites, more stakeholders or when undertaking cluster research. Possible preventative measures or solutions to the problems are suggested. Both the 'town' and 'gown' partners are required to attend to a multitude of factors when embarking on collaborative community-based research.

Health protection: communicable disease, public health and infection control educational programmes--a case study from the UK.

The health protection (HP) landscape is changing. Issues related to infectious diseases in the context of global health are receiving the attention of world leaders and policy makers. In the UK, the national health policies resonate with such transformations, presenting a range of opportunities and challenges. The opportunities include the formation of a new national organisation dedicated to protecting the people's health and reducing the impact of infectious disease, the Health Protection Agency. The opportunities also include the opening of non-medical specialists's pathways in public health. The challenges represent the limited number of centres offering infection control education; the hospital focus and bias of the courses; new, resurgent and emerging infections; globalisation and travel; bacterial resistance; vaccine safety and coverage; bioterrorism; global response capacity; and visa restrictions. Within this context, this paper presents a case study of a HP educational programme at a British university in the south of England. It outlines the course design and philosophy, participants, recruitment, aims, descriptions and learning outcomes. A range of teething problems associated with the initiation and running of such programmes is considered. These include aspects related to the university, features associated with the modules, characteristics of the students, and other interconnected larger scale international issues. Some suggestions for the way forward are presented. Collectively, attention to the suggested measures can ensure that the processes that teaching programmes embrace to refine their content and delivery will equip tomorrow's professionals with the requisite HP knowledge and skills.

Education for health: case studies of two multidisciplinary MPH/MSc public health programmes in the UK.

Amidst the winds of change that are blowing across the UK public health (PH) landscape in relation to the essential abilities and national standards that are required for the 'art and science' of PH, the preparation for a new cadre of 'PH professionals' is already underway. Several postgraduate masters programmes in public health (MPH) have taken on board the challenge of addressing the requisite sets of skills and expertise as a guide to their content and delivery. Although there are recommendations regarding teaching PH to undergraduate medical students, little consensus seems to exist on teaching postgraduate PH to non-medically qualified professionals, health managers and administrators. Employing a case study approach, this article analyses the methods used, philosophies and processes, structure and organization, outcomes to date, and lessons learnt from MPH programmes implemented at two institutions in the UK. The programmes have been initiated recently, and have had the opportunity to take on board the recent national guidelines about training standards. The findings indicate that preparatory work of the programmes, and the challenges and strengths in meeting the recent policy developments in PH training are pertinent points. The MPH programmes highlight key issues in interprofessional education and its purpose, its process and its outcomes in relation to multidisciplinary specialist practice. These programmes provide a variety of models for others wishing to develop or restructure their postgraduate PH teaching programmes. The finalization of the national standards for specialist practice in PH in the UK is encouraged, along with clearer working definitions of the domains of expertise required. Collectively, attention to these measures can ensure that the processes which teaching programmes embrace to refine their content and delivery will equip tomorrow's professionals with PH knowledge and skills.

New skills for a new age: leading the introduction of public health concepts in healthcare curricula.

Health policy in the UK is going through significant changes. At the heart of the transformation is a dedicated focus on public health. The new primary-care-based health system will not only be premised on a specialist public health workforce, but also on broader based public-health-oriented health professionals. Within primary care, widening the foundation of health professionals with public health competencies suggests that higher education bodies will need to adapt their curricula to an approach that highlights population-based health principles, preventive philosophy, and public health concepts and methods. The first part of this paper describes the mapping of the public health content of healthcare curricula at one university in England, based on the 10 public health standard areas of competencies of the Faculty of Public Health Medicine. The second part examines, through the findings of a strengths, weaknesses, opportunities, threats (SWOT) analysis, the factors that advocates for a public-health-oriented educational strategy must examine before embarking on the instigation and development of public health concepts in the healthcare curricula. The aspects that necessitate consideration include strengths such as the prevailing policy, market forces, commitment, and motivation to the effort, and the availability of resources, information and external contacts. Features such as political drive and advocacy, interest in the education debate, collaborative links through joint working and partnerships, and ongoing internal reforms and restructuring could all act as opportunities. However, resistance and anxiety are to be expected, the operationalization of the effort and empowerment of those leading it need to be thought about, and issues of control and interests are critical. The presence of conflicting priorities and competition or the lack of vision and directives, or uncertainty about change, could act as threats and barriers to the effort. If shifting the 'traditional' healthcare curricula to a more 'innovative' public-health-oriented one is to be a success, administrators of educational change will need to take into account a 'melange' of factors and stakeholders involved in a gradual and incremental process.

Narrowing the gap between academic professional wisdom and community lay knowledge: perceptions from partnerships.

Community involvement in health through community partnerships (CPs) has been widely advocated. Putting CPs into practice is complex and represents a challenge for all the stakeholders involved in the change process. Employing data from five CPs aiming to bring together communities, academics and health service providers in South Africa, this paper aims to examine and compare the views of the health care professionals with those of the community members with respect to each other's skills and abilities. Five domains of expertise in partnership working are examined: educational competencies; partnership fostering skills; community involvement expertise; change agents proficiencies; and strategic and management capacities. The findings suggest that the community recognizes the expertise and abilities brought by the professional staff to the CPs. Community members have a positive view of the capabilities of the professionals, in particular their abilities as resource persons in the areas of budget management, policy formulation and the introduction and management of change. The professionals, on the other hand, are cautious regarding the level of skill and capability in communities. The limited appreciation of community skills by the professionals covered all the five domains of expertise examined. The findings suggest that if joint working is to survive, the professionals will need to increase their valuation of the indigenous proficiencies inherent in their community partners. We conclude that programme models need to consciously incorporate in their design and implementation, capacity building, skills transfer and empowerment strategies.

Passive smoking in children: facts and public health implications.

This study measured cotinine/creatinine ratios among 60 children in Alexandria, Egypt whose parent(s) smoked and 20 control children whose parents reported not smoking to show that passive smoker children were more exposed than controls. Among the passive smoker children, girls were more exposed, 35% of the population burden of cotinine was among those aged 0-2 years, and exposure significantly decreased with the child's age. Passive smoker children whose fathers smoked "lighter" cigarettes had higher exposure levels than those whose fathers smoked regular brands. Educational programmes should increase awareness of the ill-effects of environmental tobacco smoke, and health professionals should advise parents who smoke on quitting smoking rather than switching to a "lighter" cigarette brand.

Passive smoking in children: facts and public health implications

This study measured cotinine/creatinine ratios among 60 children in Alexandria, Egypt whose parent[s] smoked and 20 control children whose parents reported not smoking to show that passive smoker children were more exposed than controls. Among the passive smoker children, girls were more exposed, 35% of the population burden of cotinine was among those aged 0-2 years, and exposure significantly decreased with the child's age. Passive smoker children whose fathers smoked "lighter" cigarettes had higher exposure levels than those whose fathers smoked regular brands. Educational programmes should increase awareness of the ill-effects of environmental tobacco smoke, and health professionals should advise parents who smoke on quitting smoking rather than switching to a "lighter" cigarette brand