bluuebunny/crossref_metadata_2025 huggingface dataset:
Rates of Mental Illness and Suicidality in Immigrant, Refugee, Ethnocultural, and Racialized Groups in Canada: A Review of the Literature
Authors: Hansson Emily K , Tuck Andrew , Lurie Steve , McKenzie Kwame
Published: January 2017

Objective:

Studies from around the world point to differences in the rates of mental illnesses between immigrant, refugee, ethnocultural, and racialized (IRER) groups and host populations. Risk of illness depends on social contexts; therefore, to offer the best information for people aiming to develop and offer equitable services, local information on rates of mental illness in different population groups is required.

Methods:

We performed a literature review of peer-reviewed journals and the grey literature between 1990 and 2009 using standard techniques and identified primary research reporting the rates of mental illness and suicidality in IRER groups in Canada.

Results:

Among the 229 papers we reviewed, 17 were included. Most papers reported rates for depression. There was no clear pattern, with different IRER groups and different age groups reporting either elevated or lower rates, compared with white Canadians. Refugee youth in Quebec have higher rates of numerous mental health problems and illnesses. When immigrant groups were considered as a whole, suicide rates were low but different national origin groups reported different trajectories in rates across the generations.

Conclusion:

The literature on rates of mental illness and suicidality in IRER groups in Canada is diverse and not comprehensive. In addition, most research has been conducted in 3 provinces and, in particular, 3 major cities. The rates of mental illness seem to vary by national origin groups, age, and status in Canada. There is very little research on nonimmigrant, culturally diverse populations in Canada. This lack of information may undermine efforts to develop equitable mental health services for all Canadians.
Substantial Changes in Prescription Recommendations for Bipolar Disorder in Canada: 2002–2010
Authors: Bulloch Andrew GM , Bresee Lauren C , Beck Cynthia A , Patten Scott B
Published: January 2017

Objectives:

We examined trends in prescription recommendations for treatment of bipolar disorder (BD) in Canada during 2002–2010.

Methods:

Data collected by IMS Brogan in a database known as the Canadian Disease and Therapeutic Index were used for this analysis. These data are collected from a representative physician panel who record each drug recommendation and reason for recommendation in their practices for 2 consecutive days each calendar quarter of the year. Prescription patterns of medications for BD, including lithium, anticonvulsants, antipsychotic agents, anxiolytics, and antidepressants, were evaluated both for general practitioners and for specialists.

Results:

The number of prescription recommendations for BD increased by 72.1% from 2002 to 2009, and then dropped by 24.8% from 2009 to 2010. This increase from 2002 to 2009, and subsequent decrease from 2009 to 2010, was observed for all classes of medications. The overall increase from 2002 to 2010 was statistically significant for the atypical antipsychotics ( P = 0.04). The largest change for an individual drug during this period was a 438% increase in recommendations for quetiapine ( P = 0.01).

Conclusions:

The number of prescription recommendations for BD increased substantially from 2002 to 2009 and sharply dropped in the following year. These results suggest that the infuence of the concept of the bipolar spectrum and its promotion may have resulted in a substantial increase in treatment that has recently begun to wane.
Treatments for the Challenging Behaviours of Adults with Intellectual Disabilities
Authors: Matson Johnny L , Neal Daniene , Kozlowski Alison M
Published: January 2017

Objective:

To provide an overview and critical assessment of common problems and best evidence practice in treatments for the challenging behaviours (CBs) of adults with intellectual disabilities (IDs).

Method:

Commonly observed problems that present obstacles to successful treatment plans are discussed, followed by an analysis of available research on the efficacy of behavioural and pharmacological therapies.

Results:

Behavioural and pharmacological interventions are most commonly used when addressing CBs in people with IDs. However, within each of these techniques, there are methods that have support in the literature for efficacy and those that do not. As clinicians, it is important to follow research so that we are engaging in best practices when developing treatment plans for CBs.

Conclusions:

One of the most consuming issues for psychiatrists and other mental health professionals who work with people who evince developmental disabilities, such as IDs, are CBs. These problems are very dangerous and are a major impediment to independent, less restrictive living. However, there is a major gap between what researchers show is effective and much of what occurs in real-world settings.
Emergency Department Visits and Use of Outpatient Physician Services by Adults with Developmental Disability and Psychiatric Disorder
Authors: Lunsky Yona , Lin Elizabeth , Balogh Rob , Klein-Geltink Julie , Wilton Andrew S , Kurdyak Paul
Published: January 2017

Objective:

To compare the emergency department (ED), primary, and psychiatric care visit rates associated with the presence and absence of a developmental disability (DD) and a mental illness.

Method:

This is a population-based study comparing Ontario adults, with and without DDs and mental illnesses, in terms of rates of primary, psychiatric, and ED care, from April 2007 to March 2009.

Results:

In Ontario, 45% of adults with a DD received a psychiatric diagnosis during a 2-year period, and 26% of those with a psychiatric diagnosis were classified as having a serious mental illness (SMI), compared with 8% of those with a psychiatric diagnosis but no DD. People with DDs had an increased likelihood of psychiatric and ED visits. Patients with SMIs and DDs had the highest rates of such visits.

Conclusions:

People with more severe impairments had the greatest likelihood of ED visits, despite access to outpatient services, suggesting that outpatient care (primary and psychiatric), as currently delivered, may not be adequate to meet their complex needs.
Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder
Authors: Katz Joel , Rosenbloom Brittany N , Fashler Samantha
Published: January 2017

Unlike acute pain that warns us of injury or disease, chronic or persistent pain serves no adaptive purpose. Though there is no agreed on definition of chronic pain, it is commonly referred to as pain that is without biological value, lasting longer than the typical healing time, not responsive to treatments based on specific remedies, and of a duration greater than 6 months. Chronic pain that is severe and intractable has detrimental consequences, including psychological distress, job loss, social isolation, and, not surprisingly, it is highly comorbid with depression and anxiety. Historically, pain without an apparent anatomical or neurophysiological origin was labelled as psychopathological. This approach is damaging to the patient and provider alike. It pollutes the therapeutic relationship by introducing an element of mutual distrust as well as implicit, if not explicit, blame. It is demoralizing to the patient who feels at fault, disbelieved, and alone. Moreover, many medically unexplained pains are now understood to involve an interplay between peripheral and central neurophysiological mechanisms that have gone awry. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, somatic symptom disorder overpsychologizes people with chronic pain; it has low sensitivity and specificity, and it contributes to misdiagnosis, as well as unnecessary stigma. Adjustment disorder remains the most appropriate, accurate, and acceptable diagnosis for people who are overly concerned about their pain.
Long-Term Consequences of Neonatal Injury
Authors: Beggs Simon
Published: January 2017

The maturation of the central nervous system's (CNS's) sensory connectivity is driven by modality-specific sensory input in early life. For the somatosensory system, this input is the physical, tactile interaction with the environment. Nociceptive circuitry is functioning at the time of birth; however, there is still considerable organization and refinement of this circuitry that occurs postnatally, before full discrimination of tactile and noxious input is possible. This fine-tuning involves separation of tactile and nociceptive afferent input to the spinal cord's dorsal horn and the maturation of local and descending inhibitory circuitry. Disruption of that input in early postnatal life (for example, by tissue injury or other noxious stimulus), can have a profound influence on subsequent development, and consequently the mature functioning of pain systems. In this review, the impact of neonatal surgical incision on nociceptive circuitry is discussed in terms of the underlying developmental neurobiology. The changes are complex, occurring at multiple anatomical sites within the CNS, and including both neuronal and glial cell populations. The altered sensory input from neonatal injury selectively modulates neuronal excitability within the spinal cord, disrupts inhibitory control, and primes the immune system, all of which contribute to the adverse long-term consequences of early pain exposure.
Treatment of Bipolar Depression: A Survey of Canadian Psychiatrists
Authors: Sharma Verinder , Mazmanian Dwight S , Persad Emmanuel , Kueneman Karen M
Published: January 2017

Objective

This study was conducted to examine how Canadian psychiatrists manage bipolar depression.

Method

A questionnaire specific to the treatment of bipolar depression was mailed to 1639 active members of the Canadian Psychiatric Association.

Results

Seven hundred and sixty-six completed questionnaires were returned (46.7%). Most psychiatrists indicated that a combination of psychotherapy and somatic therapy was their preferred approach. For bipolar disorder, depressed, lithium carbonate and selective serotonin reuptake inhibitors (SSRIs) were the preferred treatment strategies. For substitution, tricyclic antidepressants (TCAs) were the favoured choice. Lithium carbonate was the preferred choice for augmentation and addition.

Conclusion

These findings indicate that a combination of psychotherapy and somatic therapy is the preferred treatment approach for bipolar depression. Lithium carbonate and SSRIs are the favoured somatic therapies.
Individual Differences in Posttraumatic Distress: Problems with the DSM-IV Model
Authors: Bowman Marilyn Laura
Published: January 2017

Objective:

To evaluate the evidence concerning the role of threatening life events in accounting for clinically significant posttraumatic stress responses.

Method:

Research was examined to review the epidemiology, evidence of dose-response relations, and individual difference factors in accounting for variations in conditions, including posttraumatic stress disorder, after exposure to threatening events.

Results:

The evidence is significantly discrepant from the clinical Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) model. Greater distress arises from individual differences than from event characteristics. Important individual differences that interact with threat exposures include trait negative affectivity (neuroticism); beliefs about emotions, the self, the world, and the sources and consequences of danger; and preevent acts, disorders, and intelligence. Reasons for the discrepancies between the evidence and the current model of posttraumatic distress are proposed.

Conclusion:

In accounting for responses to threatening life events, the relatively minor contribution of event qualities compared with individual differences has significant treatment implications. Treatment approaches assuming that toxic event exposure creates a posttraumatic disorder fail to consider individual differences that could improve treatment efficacy.
Cognitive Therapy for Bipolar Depression: A Pilot Study
Authors: Zaretsky Ari E , Segal Zindel V , Gemar Michael
Published: January 2017

Objective:

While the efficacy of cognitive-behaviour therapy (CBT) for the treatment of acute unipolar major depression is well-documented, there is almost no data evaluating its utility in the treatment of bipolar depression. This pilot study compares the efficacy of CBT combined with mood-stabilizer pharmacotherapy for bipolar depression and CBT alone for unipolar depression.

Method:

A matched-case control design was used to evaluate outcomes following 20 sessions of CBT in 11 depressed bipolar patients and 11 matched recurrent unipolar depressed control subjects.

Results:

Bipolar depressed patients achieved similar levels of reduction in depressive symptoms following CBT, as did the unipolar depressed group. However, on measures of more pervasive dysfunctional attitudes, bipolar patients did not improve to the same degree.

Conclusions:

Preliminary findings suggest that CBT warrants further investigation as an effective psychosocial intervention for depression in bipolar patients already receiving ongoing mood-stabilizing pharmacotherapy.
Salivary Melatonin as a Circadian Phase Marker: Validation and Comparison to Plasma Melatonin
Authors: Voultsios Athena , Kennaway David J. , Dawson Drew
Published: January 2017

There are many situations in which it would be useful to know the phase state of the biological clock. It is recognized that measurement of melatonin levels can provide this information, but traditionally blood has been used for the analysis, and there are many problems in extending the measurements into the home or field situations. The aim of this study was to develop and validate a salivary melatonin radioimmunoassay and to compare results obtained against a plasma assay for determining the onset of melatonin secretion. The assay developed was sensitive (4.3 pM) and required only 200 μl of sample. A rhythm in melatonin was detected in saliva, peaking at approximately 120 pM or 30% of the plasma levels. Using an objective criterion for determining the onset of secretion (mean ± 2 standard deviations of three daytime samples), the time of onset was shown to exhibit low intraindividual variability (coefficient of variation = 1.5%-4.3%). The time of onset determined using saliva was significantly correlated with the plasma onset (r = .70, p < .05). The onsets determined were 22:30 h ± 22 min for the saliva and 21:50 h ± 16 min for plasma for 17 subjects. Similarly, the acrophases of the saliva and plasma melatonin rhythms were significantly correlated. Neither posture alone nor changes in posture affected the calculation of the onset of melatonin secretion using the saliva approach. Very high saliva flow rates induced by citric acid resulted in lower melatonin concentrations compared to the gentle chewing on parafin film. These results firmly establish the use of salivary melatonin measurements for phase typing of the melatonin rhythm in humans.
Teaching Infection Prevention
Authors: Regec Kristi L.
Published: January 2017

The process of teaching infection control is an elementary subject for home health care agencies and their clients. It is so basic that it tends to be underemphasized and undermonitored except for fulfilling mandatory requirements. This article explores key words related to the subject and ways it might be done more efficiently and monitored more effectively. The process of how we learn is also discussed and some samples of learning tools are provided.
Vital Energy the Antebellum Health Movement
Authors: Diane Hamilton
Published: January 2017

Abstract: While the notion of the relationship between well-being and energy attracts nurses, the idea is not new to health care. During antebellum America a “medical counterculture” embraced an assortment of holistic beliefs which challenged orthodox medicine.

This historical essay describes the holistic health movement of the 1800's and emphasizes the notion that health is both a product and a prisoner of any epoch's social, economic, and intellectual context. Although the past is not prologue, the essay suggests patterns and reactions of the health movement which will seem familiar to holisic health nurse practioners. The conceptual struggle of mind/body interaction and the questions regarding which entity has priority or supremacy have puzzled health practioners for centuries.
Health Status and Health Professional Visits in a Rural Area
Authors: Rohrer James E. , Vaughnt Thomas , Knott Astrid , Westermann Jorg
Published: January 2017

Visits to physicians (MDs), physician assistants (PAs) or nurse practitioners (NPs) by residents of a rural county in the upper-middle west of the United States were analysed in this study. A telephone survey yielded 250 responses. The dependent variable was the natural logarithm of the number of times the respondent had seen a health professional (MD, PA or NP) in the past two years. Predisposing, enabling and medical need variables were tested as potential predictors of visits. Self-rated health status, being unable to perform usual activities, and feeling upset or ‘down in the dumps’ proved to be important predictors, as was having a usual source of care. Health insurance coverage and family income was not, however. Unexpectedly, smokers also reported more visits. The implications for policy and future research are discussed
Career Patterns of Healthcare Executives
Authors: Fahey Daniel F. , Myrtle Robert C.
Published: January 2017

This research examines the job and career changes of healthcare executives and managers working in different segments of the healthcare industry in the western United States. The results suggest that the job and career patterns in the healthcare delivery sector are undergoing significant transformation. One third of the respondents report that at least one of their last four job changes was involuntary or unplanned. One half of those attempted to make a career change. This study identifies four different executive and management career patterns. The most common was one of multiple career changes. The second pattern was that of a single career change, followed by a ‘traditional’ career in which one did not seek a career change. The final pattern was characterized as a movement back and forth between two different segments of the healthcare industry. Age, gender, marital status and education were not associated with any specific career pattern. The need to achieve results early in the respondent's career had a strong influence on career patterns. This study confirms the fluidity of career movement and the changing permeability between the various segments of the healthcare industry. It also suggests that career success increasingly will require broad management experience in those different segments.
Mediating the Cultural Boundaries between Medicine, Nursing and Management—the Central Challenge in Hospital Reform
Authors: Degeling P. , Kennedy J. , Hill M.
Published: January 2017

This paper documents the resilience of medical and nursing profession-based subcultures and the extent of the differences between them. Against this background, we assess the capacity and willingness of medical and nursing managers to promote changes that will extend the accountability of clinicians and engender more evidence-based, financially driven and output-oriented approaches to service delivery.
Effects of Price Regulation on Stock Returns of Publicly Traded Companies in the Healthcare Industry
Authors: McCue Michael J. , Pawlukiewicz James E. , Eastaugh Steve R.
Published: January 2017

During the 1980s, governmental changes were enacted to suppress the rising costs of healthcare. The primary forms of legislation were the implementation of the Prospective Payment System (PPS), the passage of Deficit Reduction Act and the proposal to shift capital costs to a prospective payment system. The main emphasis of the study is to examine the price reaction of hospital management companies for the above governmental changes. Using an intervention analysis, the findings show that the market reacted negatively at the passage of PPS and the future proposal to implement capital costs on a prospective basis for hospital management companies. In addition, hospital management companies level of risk increased for all the key event dates.
Unrecognised Structural Implications of Casemix Management
Authors: Degeling Pieter J.
Published: January 2017

This paper takes issue with some conceptual and hence practical shortcomings which underlie current attempts to use casemix methodologies in bringing medical clinicians within the writ of management. The reform programme is grounded in an instrumental conception of organisation which construes the conduct and structuring of relationships in a hospital as being the product of its alleged purposive character and its formal design features. Accordingly, it is assumed that improving hospital efficiency and effectiveness requires no more than recasting formal authority structures and introducing information systems which will extend management's capacity to surveil and control the performance of clinical work. The paper argues that this conception of hospital organisation and what is required to achieve reform, ignores institutional prerequisites which underpin management in industrial and commercial settings and denies evidence about a range of factors inherent in the prevailing organisation of medicine which militate against efforts to extend the writ of management over hospital-based medical work.
Do Formal Controls Always Achieve Control? The Case of Triage in Accident and Emergency Departments
Authors: Read Susan , Broadbent Jane , George Steve
Published: January 2017

Triage is the term used to describe the formal process of assigning urgency categories to patients arriving in a hospital accident and emergency department. This paper uses insights from literature on management control, medical sociology and nursing to illuminate the results of a research study comparing formal triage with an informal prioritisation process carried out by nurses. Topics discussed include whether triage is a bureaucratic process, whether it allows nurses' intuition to be expressed, whether it masks the urgency of the condition of the small number of seriously injured or ill patients, and whether responsibility for decisions on urgency should be separated from responsibility to act on those decisions. It is concluded that managers must consider these questions in the light of arrangements in their own hospital; departmental layout as well as the nursing staff's experience and commitment need to be taken into account.
Decentralisation, Integration and Accountability: Perceptions of New Zealand's Top Health Service Managers
Authors: Malcolm Laurence , Barnett Pauline
Published: January 2017

This paper reports on the findings of a representative survey of senior managers within New Zealand's health system. Respondents report most favourably upon the implementation of a new organisational structure, service management, which appears to have largely replaced the traditional division of health services into hospitals and community services. Service management, which is the decentralisation of decision making to integrated patient groupings, i.e. medicine, surgery, mental health, women's health, primary health care etc., appears to have been remarkably successful, in the view of the respondents, in achieving greater efficiencies, better quality care, better decision making about priorities and greater accountability of doctors. A majority of respondents consider that services have replaced hospitals as organisational entities. Significant progress is reported in the integration of hospital and community services, primary and secondary care, preventive and treatment services and of public, private and voluntary services through service management. The findings point to a new paradigm which may be of fundamental significance in the future organisation of health services.
Linking Cost Control Measures to Health Care Services by Using Activity-Based Information
Authors: Hoyt Ronald E. , Lay Colin M.
Published: January 2017

Canada's health care institutions are under pressure to limit expenditures, maintain or increase productivity, and assimilate new technology. Even though more than 75% of hospital operating expenditures are controllable, according to a study by the Economic Council of Canada, cost systems are needed to provide essential management information. The new Canadian Management Information System (MIS) Guidelines for health care are designed to provide accurate cost measurement of patient treatment and to help managers evaluate the impact of planned program changes on areas of operational responsibility. Other potential benefits of implementing the MIS guidelines include correcting dysfunctional funding of health care units with benchmarking and setting high reporting standards for resource use at the patient level (MIS, 1991). This paper focuses on one important aspect of bringing these costs under control by examining the relation between cost deviations (variances) and underlying cost drivers. Our discussion will lead to the conclusion that incompatibility of DRG methodology and traditional cost accounting models may be an important source of cost variability within diagnostically-related disease groupings.
Developing the Doctor Manager: Reflecting on the Personal Costs
Authors: Mark Annabelle
Published: January 2017

These reflections focus on the development of doctors as managers in the National Health Service and the way that their participation is directly influenced by the personal costs perceived to their professional roles as doctors. Research has indicated some of the problems surrounding the development of doctors as managers. Although training has led to a reduction in stress, women doctors are having to contend with a glass ceiling which is double and even sometimes triple glazed, team development is not being addressed adequately, and succession planning is occurring by default rather than design. The application of domain theory to the issue can provide some guidance for the organisation, but as individual organisations like hospitals interpret these changes in a unique way, it is suggested that the key training for the future will need to focus on transition skills between organisations, and will require interpretive and adaptive responses from both doctors and managers if they are to continue to collaborate successfully in the managerial domain.
An Efficient Fault-Tolerant Order Entry Management Information System Based on Special Distributed Client/Server Architecture
Authors: Chuang Chen-Tsun
Published: January 2017

An automatic order entry system is very important for the processing of out-patient information, not only helping doctors to enter their orders directly but also reducing errors of communication. Many hospitals are anxious to set up a direct order entry system but are concerned about possible system failures. In this paper we report on an effective and efficient fault-tolerant order entry management system which satisfies the requirements for out-patient order entry. From the results of experiments on a prototype we found that the system was user friendly and reduced the time taken. Doctors are able to enter their orders more easily, accurately and quickly by selecting from the standardized and personalized menus to be found in the system.
William Brouncker MD Viscount Castlelyons (c 1620–84) First President of the Royal Society
Authors: Breathnach Caoimhghín S
Published: January 2017

William Brouncker was the grandson of Sir Henry Brouncker, President of Munster during the Elizabethan Plantation of Ireland in the 16th century. William's date and place of birth are uncertain; he was born about 1620, most probably at Castlelyons, County Cork, and educated at Oxford where he shone in mathematics and languages. Until his death in 1684 he served the Stuarts as a senior member of the Navy Board from which sprang the Admiralty, and we owe much of what we know about his life to the warts-and-all diary of his younger naval colleague, Samuel Pepys (1633–1703). Although William was granted a doctorate in medicine by Oxford in 1646, music and mathematics were his major interests. He was the first President of the Royal Society and he held that position from 1662 to 1677, when his tenure was brought to a reluctant close by an election, sardonically recorded in the diary of the curator of experiments, Robert Hooke (1635–1703). If Brouncker did not add any empirical facts, he certainly contributed to the promotion and dissemination of natural knowledge.
Is Psychological Wellbeing Impaired in Long Term Survivors of Breast Cancer?
Authors: Ellman R , Thomas B A , Ellman R
Published: January 2017

Objective

To measure anxiety and depression in long term survivors of breast cancer.

Design

Case-control study.

Setting

Follow up of the trial of early detection of breast cancer in the South West Surrey Health District.

Subjects

331 patients with breast cancer aged 50–78, attending mammographic follow up, who had been invited to screening before diagnosis, and 584 controls who had attended the same clinic but did not have breast cancer. The sample included 290 pairs matched by screening attendance pattern and year of birth.

Main Outcome Measure

– Anxiety and depression scores on the Hospital Anxiety and Depression Scale.

Results

Significantly fewer symptoms of anxiety and depression were reported by patients with cancer than by controls and significantly fewer had high scores suggesting the presence of psychological morbidity meriting treatment. Among the patients with cancer anxiety was more common at the first annual follow up than at later visits. Symptom scores were not significantly related to the manner of detection or to the type of initial treatment. Potentially confounding social and personal factors did not account for the differences between patients with cancer and controls.

Conclusion

The prevalence of anxiety and depression is not increased in long term survivors of breast cancer who are apparently free from disease and is not substantially affected by the manner in which a cancer is detected or by the treatment given. In the light of these findings it is difficult to justify large “quality adjustments” to the estimates of recurrence-free years of life saved by screening. Those who counsel patients with breast cancer should be aware that although the initial distress can be severe, meriting psychological treatment, patients do recover their normal ability to enjoy life.
Growth Screening and Urban Deprivation
Authors: White E , Wilson A , Greene S A , Berry W , McCowan C , Cairns A , Ricketts I
Published: January 2017

Objectives —

To assess the effect of urban deprivation on childhood growth in a modern British society by analysing data from a regional growth survey, the Tayside growth study.

Setting —

The Tayside Region in Scotland, which has three districts with distinct socioeconomic status: Dundee (D, urban city), Angus (A, rural), and Perth (P, rural and county town).

Subjects and methods —

Height and weight of 23 046 children (>90% of the regional childhood population) were measured as part of a child health surveillance programme, by community health care workers at 3, 5, 7, 9, 11, and 14 years. Height standard deviation score (calculated against Tanner) and body mass index (BMI-weight (kg)/height (m)2) were calculated for each child by a central computer program; mean height standard deviation score and BMI standard deviation score were calculated for each measuring centre (school, health clinic). A deprivation score for each centre was calculated from the prevalence of single parent families; families with more than three children; unemployment rate; the number of social class V individuals; the percentage of council houses.

Results —

Mean height standard deviation score for Tayside was 0·11. An intra-regional difference was demonstrated: mean height standard deviation score (SD) D = 0·04 (1·0); A = 0·14 (1·1); P = 0·21 (1·1); P<0·002. There was a positive association between short stature and increasing social deprivation seen throughout Tayside (P<0·05), with a strong association in Dundee primary school children (r = 0·6; P<0·001). Analysis by district showed that the association was significant only above the age of 8 (P<0·004). There was no relation between BMI and social deprivation.

Conclusions —

In an industrialised developed society, urban deprivation appears to influence height mostly in late childhood, and this association should be taken into consideration in the clinical management of short stature. Height seems to be a better physical indicator of urban deprivation, and hence an index of childhood health, than BMI.
United Kingdom Community Growth Screening 1994: A Survey of Current Practice
Authors: Hulse J A , Schilg S ,   For the “Screening for Growth Towards 2000” Scientific Organising Committee
Published: January 2017

Objective —

To determine current policies, resources, and attitudes to community growth screening in the United Kingdom.

Methods —

A postal survey of community paediatricians and paediatric endocrinologists.

Results —

164 replies were received – most from senior clinical medical officers or community paediatricians – covering between 68 and 78% of the United Kingdom population. One hundred and thirty three (81%) trusts or districts had a written growth policy. Preschool and school age height screening took place in 75% and 81% of districts respectively, but most children were only measured once before school or at school. Policies for the age at which measurements were made and their frequency varied enormously. Seventy three per cent used standard equipment, the most popular being the Millimetre. A wide variety of charts were used, of which 23% were decimal age charts. A large number of referral criteria were used, including height, height velocity, and weight. Most children were referred to hospital outpatient clinics rather than specialist growth clinics.

Conclusions —

Over 90% of respondents felt that growth screening was either extremely valuable or useful depending on resources. The survey showed a widespread lack of standardisation of equipment, charts, and policies. Referral criteria and objectives need to be clarified by research and audit, and growth monitoring integrated into a systematic programme of child health surveillance.
Can We Measure Growth?
Authors: Voss Linda D
Published: January 2017

Poor installation and maintenance of height measuring equipment is a serious problem in the community. With care, however, height can be measured with sufficient precision (± 0.5 cm) to identify unusually short or tall stature. Height velocity, on the other hand, is liable to misinterpretation. It cannot be estimated with sufficient precision to identify abnormal growth in the short term. There is no correlation between two successive 12 month velocities. When a trend towards poor velocity is beyond all doubt then it will be apparent on the height chart alone. In addition, “poor” or “excessive” growth is conditional on the height of the child: short children do not grow at the same rate as tall.

A diagnosis of abnormal growth requires long term monitoring and is best seen as a series of height measurements crossing the centiles on the height chart.

Given the correct equipment and training, height or length can be measured with a fair degree of precision in the youngest of children. The earlier measurements begin, the sooner an abnormal pattern of growth will become evident. The regular monitoring of height should be standard practice and available to each and every child.
An Offshore Silicon Valley? The Emerging Irish Software Industry
Authors: Riain Seán Ó
Published: January 2017

This paper assesses the development potential of local inter-firm networks in Newly Industrializing Countries. This is done through an analysis of the role of such networks in the growth of the software industry in the Republic of Ireland. Transnational software companies located in Ireland developed extensive local supply networks. Local social networks and a local culture of innovation contributed to the growth of an indigenous software development sector.

While local networks can generate significant competitive advantage for a region they are inevitably internationalized as successful firms organize globally or as the region attracts further foreign investment. Corporations utilize local networks to solve problems of cost, control and innovation management in the globalization of production and corporate organization. While fostering local networks can be an effective public policy, it is not sufficient for development. The role of the state in supporting, guiding and bargaining with local firms in these networks remains a crucial aspect of development strategy.
The New Macrolide Antibiotics: Azithromycin, Clarithromycin, Dirithromycin, and Roxithromycin
Authors: Bahal Neeta , Nahata Milap C.
Published: January 2017

OBJECTIVE:

To review the chemistry, antimicrobial spectrum, pharmacokinetics, clinical trials, adverse effects, and drug interactions of four new macrolide antibiotics: Azithromycin, clarithromycin, dirithromycin, and roxithromycin.

DATA SOURCES:

Information was obtained from comparative clinical trials, abstracts, conference proceedings, and review articles. Indexing terms included azithromycin, clarithromycin, dirithromycin, erythromycin, roxithromycin, and macrolide antibiotics.

STUDY SELECTION:

Emphasis was placed on comparative clinical trials involving the new macrolide antibiotics.

DATA EXTRACTION:

Data from human studies published in the English language were evaluated. Trials were assessed by sample size, macrolide dosage regimen, and therapeutic response.

DATA SYNTHESIS:

The erythromycins have gained widespread use in treating a variety of infections. Although they are effective, limitations include the need to administer four times a day and the intolerable adverse gastrointestinal effects. Four of the more extensively studied agents, azithromycin, clarithromycin, dirithromycin, and roxithromycin, are currently being studied in patients. Based on the studies to date, the newer macrolides may offer several advantages over erythromycin, including: (1) greater antimicrobial activity against certain organisms; (2) longer elimination half-life, thus allowing less frequent administration; and (3) lower incidence of adverse gastrointestinal effects.

CONCLUSIONS:

The new macrolide antibiotics appear to offer an improvement over erythromycin. Definitive conclusions about the role of these drugs should await completion of ongoing clinical studies.
Computers in Healthcare: Overview and Bibliography
Authors: Dasta Joseph F. , Greer Marianne L. , Speedie Stuart M.
Published: January 2017

OBJECTIVE:

The objective of this article is to provide an overview of computer technology and an associated bibliography, emphasizing institutional-based healthcare applications and pharmacoinformatics.

DATA SOURCES:

References were selected from the authors' files and from a computerized search over the last five years on computers in healthcare/medical informatics and in pharmacy.

STUDY SELECTION:

Articles selected for review and discussion were considered to be important contributions to the respective areas listed in the bibliography and representative of advancements in computer applications in healthcare and pharmacy.

DATA SYNTHESIS:

The computer has become an important support tool for healthcare professionals. Medical informatics and the discipline related to pharmacy, called pharmacoinformatics, have evolved from the cognitive underpinnings of medicine, pharmacy, and computer science. Recent developments in computer technology have resulted in computers that are fast, increasingly portable, and user friendly. Hospital information systems employ computers in various ways to deal with the vast amount of information used by various departments. Standards for electronic data exchange are being developed to increase the integration potential of these systems. Hospital pharmacists have used computers for drug distribution, financial analysis and inventory control, drug interaction detection, pharmacokinetic dosing, drug information, and drug therapy monitoring. Expert systems are being developed in several areas of drug therapy. Pharmacy educators have developed interactive courseware to help students learn problem-solving skills in the areas of calculations, therapeutics, and drug information.

CONCLUSIONS:

Pharmacists need to become more involved with applications of technology to pharmacy. Properly implemented, computers can provide more time for pharmacists to use their cognitive skills in the delivery of pharmaceutical care.
Availability of Narcotics and Pharmacists' Attitudes toward Narcotic Prescriptions for Cancer Patients
Authors: Holdsworth Mark T. , Raisch Dennis W.
Published: January 2017

OBJECTIVE:

To determine narcotic availability and pharmacist apprehension toward dispensing narcotics for cancer patients.

DESIGN:

Mailing of a one-page survey.

SETTING:

All pharmacies in the state of New Mexico.

PARTICIPANTS:

Of the 309 pharmacies, 76.1 percent (235) completed the survey.

MEASUREMENTS AND MAIN RESULTS:

Apprehension was significantly elevated for methadone, hydromorphone, and for morphine doses >500 mg/d (p<0.001). The most common reasons listed for apprehension were forgery (46.4 percent), theft (40.4 percent), high dosages (23.8 percent), narcotic investigations (18.7 percent), and patient addiction (9.4 percent). Hydromorphone was available (in stock) in 80.5 percent of the pharmacies, followed by morphine 30-mg sustained-release tablets (64.5 percent) and methadone (53.4 percent). The vast majority of pharmacists were willing to order strong narcotics for specific patients. Pharmacists working in chain stores expressed a higher level of apprehension toward dispensing methadone and more frequently cited forgery as a reason for apprehension. Distance from a metropolitan area and practice setting best predicted apprehension to forgery (p=0.01).

CONCLUSIONS:

Pharmacists do not appear to be a major obstruction to adequate analgesia for cancer patients in New Mexico but may require further education regarding lack of narcotic addiction and dosing in patients with cancer.
Kinematics of a Total Arthroplasty of the Ankle: Comparison to Normal Ankle Motion
Authors: Michelson James D. , Schmidt Guy R. , Mizel Mark S.
Published: January 2017

Although the concept of a total ankle arthroplasty has been advanced as a method for treating severe ankle arthritis, the clinical experience with all of the models developed has been discouraging. Both the constrained designs, which maximize joint contact area by restricting the available motion, and the unconstrained designs, which allow more normal motion at the expense of higher contact stresses, uniformly result in implant loosening, pain, and clinical failure in 2 to 7 years. This has led to the recommendation against the use of a total ankle arthroplasty except in very low-demand patients.

Failure of ankle implants can be ascribed to either anatomic considerations (e.g. -the talus is too small to accommodate the stress transfers of a prosthesis), or mechanical etiologies. Abnormal 3-dimensional motion of the ankle following arthroplasty would fall into the latter category.

This study examined the motion that occurs after implantation of an unconstrained-type total ankle arthroplasty. Using previously validated methodology, axially loaded ankle specimens were cycled through an arc of plantarflex/dorsiflexion while measuring the resulting coupled internal/external and varus/valgus rotations.

The average coupled motions in prosthetic ankles were not significantly different than their intact controls. There was, however, a significantly increased amount of hysteresis (defined as the difference between the upper and lower pathways of coupled motion at any given sagittal position) that occurred as the ankle was dorsiflexed and plantar flexed. The increased hysteresis was seen in both the axial and coronal planes. This indicates that there was a greater permitted envelop of motion in the prosthetic ankles compared to normal ankles. It is hypothesized that this subtle change in ankle kinematics caused by the arthroplasty leads to abnormal stress transfer at the prosthesis-bone interface, thereby promoting early implant failure.
Increased Bone Mineral Density Adjacent to Hydroxy-Apatite-Coated Ankle Arthroplasty
Authors: Zerahn Bo , Kofoed Hakon , Borgwardt Arne
Published: January 2017

We measured bone mineral density (BMD) in patients treated with a unilateral hydroxy-apatite-coated ankle arthroplasty. The study comprised 11 consecutive patients measured preoperatively and postoperatively after 3, 6, and 12 months (group I) and 17 patients measured once at 12 to 82 months follow-up (group II). BMD was measured in the distal tibia adjacent to the prosthesis and in the calcaneus. BMD of the calcaneus was measured bilaterally as an indicator of changes in foot load.

In group I BMD was significantly increased in the distal tibia after 6 and 12 months compared to preoperative values. In group II BMD of the distal tibia was significantly higher compared to the non-operated side. No radiolucencies were detected during follow-up in any case. The increase in BMD and the radiogaphic findings after uncemented ankle arthroplasty indicates that it is being loaded by the prosthesis. This may indicate a well fixed prosthesis.
Salvage First MTP Arthrodesis Utilizing ICBG: Clinical Evaluation and Outcome
Authors: Brodsky James W. , Ptaszek Amy Jo , Morris Scott G.
Published: January 2017

Twelve patients (12 feet) underwent salvage first metatarsalphalangeal (MTP) arthrodesis with structural, interposition autologous iliac crest bone graft (ICBG). Eight patients had a bony defect secondary to failed first MTP joint implant arthroplasties, two had avascular necrosis (AVN) after failed bunion surgery, one had a nonunion of an attempted arthrodesis for failed bunion surgery, and one had been treated for osteomyelitis after cheilectomy. Eleven of the cases had a single dorsal plate secured by screws and one case had two plates, one dorsal and one medial. A plate, crossed screw(s) and/or K-wire combination were chosen in four cases. Indications included first MTP joint pain, metatarsalgia, intractable plantar keratoses (IPK), as well as a functionally and cosmetically short first ray refractory to non surgical management. Average preoperative shortening was 8.5 mm (range 5–17). Clinical arthrodesis was achieved after an average of 12 weeks (range 4–20). Radiographic arthrodesis was achieved in eleven of twelve feet at an average of 15 weeks (range 8–28), with one pseudoarthrosis. AOFAS forefoot clinical rating score averaged 70 points (max 90 after first MTP arthrodesis) at an average follow-up of 22 months (range 5–70). Sesamoiditis, prominent hardware and scar sensitivity were prevalent complaints in four patients postoperatively. Two cases required flap coverage for skin necrosis. Relief of metatarsalgia, good hallux alignment as well as improved patient satisfaction and function were achieved in all cases. There was no symptomatic progression of interphalangeal degenerative change postoperatively.