Analysis of low birth weight first-born babies by geography and deprivation as an aid to policy and service targeting.

BACKGROUND: Low birth weight (LBW), which is defined as a birth weight of <2500 g, is considered to be an indicator of a range of negative health outcomes. METHODS: The feasibility of using child health data at small area (SA) level to explore patterns of LBW in an Irish region comprising the counties of Dublin, Kildare and Wicklow (DKW) for the 2006-2015 period was assessed. A logistic regression model was created using R software. RESULTS: LBW occurred in 5% of births to first time mothers and was associated with living in more deprived areas (OR: 1.5) and a maternal age of over 40 years (OR: 1.8). CONCLUSION: The potential of geocoding routinely collected data to explore the relationship between child health indicators and areas of deprivation, and inform the targeting of resources to reduce health inequalities is demonstrated.

Economic evaluation of chronic disease self-management for people with diabetes: a systematic review.

AIMS: To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes. BACKGROUND: Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA1c levels in people with diabetes. METHODS: Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used. RESULTS: A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias. CONCLUSIONS: Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes.

Choledochal cysts: our ten year experience.

We present our experience in the management of choledochal cysts from 1999 to 2009. A retrospective review of all charts with a diagnosis of choledochal cysts in our institution in this ten-year period. Data was collated using Excel. A total of 17 patients were diagnosed with choledochal cyst: 9 females and 8 males. The average age at diagnosis was 28 months (range from 0 to 9 years). The most common presenting symptoms were obstructive jaundice 6 (35%) and abdominal pain and vomiting 4 (23%). Ultrasound (US) was the initial diagnostic test in all cases with 4 patients requiring further investigations. All patients underwent Roux-en-Y Hepaticojejunostomy. The average length of stay was 11 days. Patients were followed up with Liver Function Tests (LFTS) and US 4-6 weeks post-operatively. Three patients developed complications including post-op collection, high drain output requiring blood transfusion and adhesive bowel obstruction. Our overall experience with choledochal cyst patients has been a positive one with effective management and low complication rates.

[Prognostic evaluation of the cardiopathy in Duchenne's muscular dystrophy]. / Valutazione prognostica della cardiopatia nella distrofia muscolare di Duchenne.

As it has now been ascertained that there is cardiac damage during the course of Duchenne muscular dystrophy (DMD), the authors have aimed at evaluating the relationship existing between the development of heart damage with respect to the advancement of age, and, at finding a sure prognostic index of the illness, easily acquired by using non-invasive techniques. Whilst the parameters which show the behaviour of the pumping function of the left ventricle (EF, Delta D%) did not demonstrate a clear correlation regarding their alteration in relation to age, the relationship PEP/LVET showed an accuracy of 92% predicting the terms of survival of patients suffering from DMD.

[Clinical and CT aspects of muscular dystonias]. / Aspetti clinici e TC nelle distonie muscolari. Clinical and CT aspects of torsion dystonias.

Clinical, EMG, genetic and CT investigations were performed on 16 subjects suffering from Torsion Dystonia. We obtained the following results: i) genetically most cases were sporadic, only two could be considered autosomic dominant; ii) one of the pedigrees, with many patients, confirmed that spasmodic torticollis is not a distinct form from that of Dystonia Muscolorum Deformans; the two forms must be included in one disease called "Torsion Dystonia", as maintained by some Authors; iii) we found that the various drugs employed, rarely produced improvement, although benzodiaze4pines have given some benefit; iv) CT findings were not specific, though useful for differential diagnosis.

CT and EEG investigations in 100 patients with multiple sclerosis (MS).

100 MS patients were followed up for an average of 5 years. We considered age at onset, duration of the disease, number of attacks, neurological and psychic status, CT and EEG findings and tried correlating the last two with all the previous factors. In remission the most frequent CT abnormality was diffuse atrophy. In acute exacerbations there were 3 possibilities: normality, hypodensity and, much more rarely, hyperdensity with pseudotumoral patterns. A normal CT and short duration of disease were positively correlated with a small number of attacks. There were no positive correlations between CT findings, age at onset and neurological and psychic status. EEG, like CT, may show no changes in a high percentage of cases but there is scant correlation between the two.

[Neurological complications in drug dependence with special reference to the development of epileptic syndromes]. / Complicanze neurologiche nelle tossicodipendenze, con particolare riguardo all'insorgenza di sindromi epilettiche.

33 drug abusers were examined and all of them were addicts to several drugs and always to heroin. Neurological complications occurred rather frequently. One patient had subarachnoid hemorrhage and angiography showed no arteriovenous malformations nor other pathology. Polyneuropathy has been found in one case. 7 patients (21,2%) developed psychotic episodes. Epileptic attacks were found in 5 cases (15,1%). Latency between the onset of drug-abusing and occurrence of the attacks was found to be at least 1 year in two cases and 3 years in the other three. 4 cases suffered from partial complex seizures with secondary generalization and one patient had generalized tonic-clonic attacks. Fits occurred rarely in all cases; one patient had two episodes of partial status. Further research is required because there are few clinical reports in comparison with the experimental ones.