bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic Retrograde Cholangiopancreatography and Endoscopic Sphincterotomy: Experience in the Sudan
Authors: Fedail Sulieman S , Gaber A Alia , Sulieman Ikhals 
Published: January 2017

Over a 5 year period 626 endoscopic retrograde cholangiopancreatography (ERCP) examinations were attempted in Khartoum, Sudan. The relevant duct was successfully cannulated and visualized in 94% of cases of biliary tract disease and in 73% of cases of pancreatic disease. This was due to the large number of cases with advanced pancreatic cancer. The commonest abnormal finding was stones in the biliary tree in 214 cases (35% of all cases). Cholangiocarcinoma was seen in 18 cases, pancreatic cancer in 64 cases, chronic pancreatitis in 48 cases and periampullary carcinoma in 20 cases. ERCP was considered normal in 100 cases. Endoscopic sphincterotomy (EST) was performed in 48 cases; 44 had common duct stones. ERCP and EST are feasible and useful procedures in a developing country. However they are expensive and should be carried out in referral centres.
Body Temperatures of Home Delivered Newborns in North India
Authors: Kumar Rajesh , Aggarwal Arun K 
Published: January 2017

In this prospective study, the axillary temperature of newborns delivered at home were recorded by a field worker once within a period of 24 h after the birth in 10 villages of Haryana, India, during 1992–1993. Room air temperature was measured at the same time. Family members were interviewed to record newborn care practices. Of the 189 babies, 11.1% were found to be hypothermic (temperature <35.6°C) and 22.8% were hyperthermic (temperature >37.3°C). During winter months 19.1% were hypothermic as compared to only 3.1% in summer whereas 8.5% were hyperthermic in winter compared to 36.8% in summer. Room air temperature of <24°C was recorded in 41%. A strong correlation was observed between room air temperature and neonatal temperature. At the time of birth, 13.2% of the delivery rooms in summer and 73.6% in winter were reported to have heat source: 58.2% babies were reported to be wiped soon after birth; 97.3% were wrapped in cloth; the head was covered in 59.1% cases in winter and 10.5% in summer; 97.3% babies were kept with mother in same bed but not in skin-to-skin contact; and 65% were bathed within 24 h after delivery. Neonatal hypothermia is a common problem in developing countries. It is important that information, education and communication strategy about appropriate technologies for prevention and management of neonatal hypothermia is provided at domiciliary level. A significant proportion of babies are likely to suffer from hyperthermia in warm countries, specially in summer. Therefore, guidelines for thermal control in home births should be tailored to the specific environmental situation.
Family Expenditure on Sickness Episodes of Pre-School Children in Urban Slums of Lucknow, North India
Authors: Awasthi Shally , Pande Vinod Kumar 
Published: January 2017

This study investigated family expenditure on the sickness episodes of pre-school children in 32 urban slums of Lucknow, North India. Between July 1995 and January 1996, 396 children between the ages of 1.5 to 3.5 years were contacted. The main objective was to discover the direct medical cost of illness incurred by their families in the preceding months. Point prevalence of major morbidities, in the preceding month, were as follows: 17.2% respiratory and 6.3% diarrhoeal. A health care provider saw 31.4% [95% confidence interval (CI): 26.9–36.01] children. In >95% of the cases, the health care provider was a self-employed, non-governmental dispenser (NGD). More than half of NGDs did not have a recognized medical degree. The mean family expenditure on sickness in 1 month was RS 12.27 [standard deviation (SD): RS 23.81], approximately 1% of their income (1 US$ = RS 32). Respiratory illness was the primary cause of financial burden to the community. The isolated symptom of fever was the most expensive to treat, with diarrhoea and dysentery costs being similar. Immunizing a child saved money. We conclude that since the NGDs are the predominant health care providers in the urban slums, and since neither the nature of medicines dispensed by them nor their additional costs can be ascertained, steps must be taken to monitor their dispensing practices and to educate them about rational drug therapy.
Growth Monitoring: Family Participation: Effective Community Development
Authors: Meegan Mike , Morley David C 
Published: January 2017

Growth monitoring was introduced into most developing countries in the 1970s with the aim of combating under nutrition in infancy and childhood. Ten years later analysis showed weight charts were not completed satisfactorily and not used in decision making. Although growth monitoring is now seldom mentioned in nutrition studies, the authors of this study are convinced of its value. With new technology using the direct recording scales (DRS), illiterate or semi-literate mothers are able to complete the growth curve on the weight chart and acquire understanding about the process and its significance for their infant. This study investigates the understanding of the growth curve by the rest of the family. The mother, their daughters and significantly, the grandmothers were shown to have comprehended the meaning of the growth curve. In families where mothers weighed their infant using the DRS, a smaller proportion were found to be suffering from periods of growth failure compared with families where the infant was weighed by community health workers with a dial scale. There are obvious gains if technologies are moved from the clinic into the family and the community. The weighing and charting of children by DRS may be a further step in the fight to overcome undernutrition in developing countries.
The Global Health Licensing Program: A New Model for Humanitarian Licensing at the University Level
Authors: Roose-Snyder Beirne , Doyle Megan K. 
Published: January 2017

Disparities in health outcomes and access to the essential medicines that affect health outcomes are two of the most pressing issues facing the world today. The lack of adequate health care in developing countries is rooted in a number of systemic problems, including insufficient health infrastructure, lack of medical personnel, government corruption and incompetence, and the high price of pharmaceuticals. These problems are not mutually exclusive. Instead, they are mutually reinforcing, particularly in least developed and developing countries.The high cost of drugs and vaccines is undoubtedly one of the driving forces in disparate health outcomes, and partial solutions to poor health in the developing world rightly focus on lowering the cost of health products, while preserving the financial incentive for innovation. The high cost of many medicines is largely due to the international patent system, codified by the Trade Related Intellectual Property Rights (TRIPS) Agreement, which grants a monopoly to the innovator and allows it to completely control pricing for a period of years. The result is an access gap, whereby patients in low- and middle-income countries (LMI) cannot afford expensive patented drugs, while patients in wealthy countries can afford and do have access to such treatments.
Human Rights in Health Equity: Cervical Cancer and HPV Vaccines
Authors: Erdman Joanna N. 
Published: January 2017

AbstractThis article seeks to demonstrate that health equity, as an empirical and normative concept, is reflected in the human rights to health and equality under international law. The obligations on government that flow from health equity as a human right are then examined. These include the obligation to act in pursuit of health equity as a policy objective, and the obligation to enact measures to ensure health equity as a policy outcome. These obligations are considered in relation to a promising remedial measure for social disparities in cervical cancer: HPV vaccines.
Is a Flat-Line a Good Thing? On the Privatization of Israel's Healthcare System
Authors: Seidman Guy I. 
Published: January 2017

AbstractIsrael presents an intriguing conundrum: on the one hand, it provides quality healthcare in a near-universal healthcare system; on the other, it has maintained healthcare costs level at approximately 7.7% of GDP. This comes at a time when all western nations struggle with one or both sides of the equation: how to offer affordable, good quality health care to the population while curbing the sharp rise in health related costs. This paper explains both how Israel has achieved this “flat line” effect and the social and political costs of this achievement.
The Nose after Laryngectomy
Authors: Moore-Gillon Victoria 
Published: January 2017

Previous studies of nasal function after laryngectomy have suggested that patients must accept complete and irreversible anosmia as an inevitable consequence of the operation, and that this is due to interruption of a poorly defined neuronal interaction between larynx and nose. In this study nasal function was investigated in 23 laryngectomees and 10 patients about to undergo laryngectomy. Scanning electron microscopy showed a more densely ciliated nasal epithelium in the laryngectomees compared with the preoperative controls, and nasal mucociliary transport, measured by saccharine clearance, was significantly faster ( P < 0.01) in laryngectomees. Olfactory acuity, as determined by the threshold for detection of insufflated pyridine vapour, was normal in laryngectomees. Some laryngectomees did have a relatively normal sense of smell; these were shown to be those who had discovered a technique of sniffing using buccopharyngeal rather than respiratory musculature. These findings have obvious implications for the rehabilitation of laryngectomees, many of whom may otherwise have to contend with distressing anosmia as well as the other physical and psychological consequences of the operation.
Problems in Diagnosis of Popliteal Aneurysms
Authors: Downing R , Ashton F , Grimley R P , Slaney G 
Published: January 2017

Clinical features and errors in diagnosis have been assessed in a retrospective study of 62 popliteal aneurysms in 40 patients, 22 of whom had bilateral aneurysms. Only 29% of patients complained of pain or swelling behind the knee, while 31% of aneurysms had produced distal ischaemia presenting as intermittent claudication, 9 aneurysms had thrombosed producing ischaemic rest pain in 6 legs, and 4 aneurysms had ruptured. Although 94% of aneurysms were suspected or confidently diagnosed by palpation alone, only 43% of patients had had the correct diagnosis made at the time of initial referral. Treatment was delayed in 12 patients, 8 of whom subsequently required amputation. Popliteal aneurysm should be suspected in patients with a prominent popliteal pulse who present with intermittent claudication, and in patients with acute ischaemia of the leg who may have a thrombosed aneurysm requiring surgical exploration.
The ‘Holding Function’ of Dynamic Psychotherapy in a Custodial Setting: A Review
Authors: Cox Murray 
Published: January 2017

The dual connotation of words such as security or identity, which both forensic psychiatry and dynamic psychology regard as their own, is nowhere more evident than in relation to the words ‘hold’ and ‘holding’. The dictionary entry under ‘hold’ includes ‘keep fast, keep possession, detain, remain unbroken, grasp, not give way, adhere to, maintain, hold out — hope — possibility’. Whereas, a group of patients at Broadmoor, an alternative source of information, offered the following associations: ‘We are held … we can't walk through the gates … we hold ourselves here by what we've done … we need to be able to hold out … we need someone to hold us … we need someone to hold on to’. Indeed, one patient felt that he had let go of the therapist ‘too soon’, thus recalling the words of Stevie Smith: ‘You have weaned me too soon, you must nurse me again’ ( The Wanderer).
Individual differences, cognitive abilities, aptitude complexes and learning conditions in second language acquisition
Authors: Robinson Peter 
Published: January 2017

Individual differences in resource availability, and the patterns of cognitive abilities they contribute to, are important to: • explaining variation between learners in the effectiveness of second language (L2) instructional treatments; • describing differences in implicit, incidental and explicit L2 learning processes; and • explaining child-adult differences in acquisition processes, and therefore to any general theory of second language acquisition (SLA). In this article I describe a framework for research into the effects of cognitive abilities on SLA which is based on four interlocking hypotheses. These hypotheses are drawn from research in psychology, education and SLA and, where possible, I present evidence to support each of them. The hypotheses are: 1) the Aptitude Complex Hypothesis; 2) the Ability Differentiation Hypothesis; 3) the Fundamental Difference Hypothesis; and 4) the Fundamental Similarity Hypothesis. The hypotheses, and the relationships between them, define an Aptitude Complex/Ability Differentiation framework for further examining the influence of individual differences in cognitive abilities on SLA, and for developing a theoretically motivated measure of language learning aptitude. I argue that such research should adopt the interactionist approach described by Snow (1994) to identifying individual difference/learning condition interactions at a number of levels. I illustrate some of these interactions.
Pysiological Evaluation of Venous Obstruction in the Post-Thrombotic Leg
Authors: Åkesson Henrik , Brudin Lars , Jensen Ragnar , Ohlin Per , Plate Gunnar 
Published: January 2017

The accuracy and value of occlusion plethysmography (OP) in assessing post-thrombotic iliac and femoral vein obstruction was determined in 45 patients (85 legs) six months after an acute iliofemoral venous thromboses using contrast phlebography (CP) as reference method. The additional value of femoral venous pressure (FVP) measurements in assessing the physiological importance of iliac vein obstructions was determined in 34 of these patients (60 legs). The sensitivity and specificity of OP in detecting femoral and iliac vein obstructions was 79% and 84% respectively. OP was unable to distinguish femoral from iliac lesions and stenosis from obstructions. A maximum venous outflow (MVO) <30 ml·100 ml−1 ·min−1 was greatly associated with venous obstruction which was very uncommon if the MVO >50 ml·100 ml−1 ·min−1. Resting FVPs were of little value in assessing iliac venous outflow. Exercise pressures and comparison with normal contralateral veins improved the association with anatomical obstruction. A difference in FVP change with exercise exceeding l mmHg as compared to the contralateral leg was most predictive of an iliac vein obstruction. Patients with obvious clinical symptoms of venous outflow obstruction (venous claudication) all had iliac vein obstruction, abnormal OP and an FVP change with exercise exceeding 5 mmHg. This demonstrates the ability of OP and FVP to reflect physiological rather than morphological post-thrombotic venous obstruction.
Relationship between Blood Groups (ABO) and Varicose Veins of the Lower Limbs. A Case-Control Study
Authors: Cornu-Thenard André , Dab William , de Vicenzi Isabelle , Valty Jean 
Published: January 2017

Numerous studies have already shown the existence of a relationship between blood groups of the ABO system and certain vascular diseases: group A and atheromatous disease1,4,5,7,9,12; group A and deep venous thrombosis of the lower limbs6,11,13. However, no study has reported an association between varicose veins and the ABO blood groups. The aim of this study was to investigate the possible existence of such an association.
Treatment of Venous Lipodermatosclerosis and Ulceration in Venous Hypertension by Elastic Compression and Fibrinolytic Enhancement with Defibrotide
Authors: Belcaro G. , Marelli C. 
Published: January 2017

The value of elastic compression and defibrotide, a profibrinolytic and antithrombotic drug, in patients with venous hypertension, lipodermatosclerosis and ulceration was assessed in a cross-over trial. Elastic compression alone and in association with defibrotide (800 mg/day) were completed the study (18 were treated with the combined treatment in the first 3 months and 14 in the second period). We evaluated the decrease of the areas of liposclerosis and ulceration by computerized analysis of the areas. We also studied the decrease of leg circumference and subjective clinical improvement by an analogue scale line. Patients were also evaluated by laser-Doppler flowimetry, transcutaneous PO2 and PCO2 measurements, capillary permeability and fibrinolytic activity. Both forms of treatment were active in reducing the areas of liposclerosis and ulceration but combined treatment with defibrotide and elastic compression was significantly more effective in reducing both liposclerosis and ulceration, and in improving microcirculatory parameters and capillary permeability. The improvement in objective evaluation was comparable to the clinical improvement measured by the analogue score. The positive variation of all parameters studied was associated with a significant increase of fibrinolytic activity during the administration of defibrotide. No side effects were observed during this study. These results suggest that defibrotide treatment is effective in treating liposclerosis and ulceration in postphlebitic limbs with venous hypertension, improving both microcirculatory parameters and subjective symptoms.
Decreased Tocopherol Concentration of Varicose Veins is Associated with a Decrease in Antilipoperoxidant Activity without Similar Changes in Plasma
Authors: Deby Carol , Hariton Claude , Pincemail Joël , Coget Jean 
Published: January 2017

Antilipoperoxidant and antiradicalar powers were determined in human varicose saphenous veins, and correlated with tocopherol content in plasma or venous homogenates. No difference was found between plasma levels of tocopherol in samples from controls (10.25 ± 1.93 μg ml−1) and from patients with varicose veins (11.50 ± 4.05 μg ml−1), while a significant decrease in tocopherol level was observed in varicose saphenous vein (4.46 ± 1.75 μg/100 mg) as compared to normal vein homogenates (6.25 ± 1.52μg/100mg). In addition, a positive linear correlation ( r = 0.939, p < 0.001) between the antilipoperoxidant activity of venous tissues and their tocopherol content was noticed, whereas no similar relation exists with the plasma tocopherol concentrations. Moreover, a negative linear correlation ( r = 0.814, p < 0.001) between plasma and vessel-wall anti-OH properties was demonstrated, without similar correlation between anti-OH power and the tocopherol levels, neither for the plasma nor for the venous samples. Concerning antiradicalar activities, a positive linear correlation ( r = 0.761, p < 0.001) was noticed between anti-OH power and anti-ferryl ion properties observed in venous wall homogenates. This study provides a new valuation in man concerning the implication of tocopherol in the oxidative status of venous tissue.
Liposclerotic Skin: A Diffusion Block or a Perfusion Problem?
Authors: Stibe E. , Cheatle T. R. , Smith P. D. Coleridge , Scurr J. H. 
Published: January 2017

There is continued debate as to whether skin damage in venous disease results from an oxygen diffusion block or from abnormal perfusion. Transcutaneous oxygen pressure and laser-Doppler flux were measured in 15 patients with chronic venous insuffiency (CVI) and lipodermatosclerosis and in 15 normal controls. The time for Tc Po2 to regain resting values after 5 min of ischaemia was measured, as was the time taken for laser-Doppler flux to reach 95% of peak flow. Tc Po2 was reduced in patients with CVI (median 26 mmHg, interquartile range (IQR) 16–46) compared to controls (median 55 mmHg, IQR 40–65). Hyperaemic responsiveness, as assessed by calculating the ratio of peak laser-Doppler flux following 5 min of ischaemia, was also reduced (median (CVI) 1.5, IQR 1.1–2; median (control 3.3, IQR 1.8–4.8). However, following ischaemia Tc Po2 took no longer to regain resting levels in venous patients than in controls, whereas there was a trend towards delay in reaching peak skin blood flow. These findings suggest a primary perfusion deficit in skin damaged by venous hypertension rather than an oxygen diffusion block.
Non-Thrombotic Deep Venous Incompetence with Special Reference to Anatomic, Haemodynamic and Therapeutic Aspects
Authors: Almgren Bo 
Published: January 2017

This investigation was undertaken to study non-thrombotic deep venous insufficiency (DVI) in patients with varicose veins or other venous symptoms. Deep venous reflux was observed in 3.5% of the ‘normal’ limbs in patients with unilateral varicose veins. A high incidence of reflux was found in limbs with untreated (21%, P < 0.001) and with recurrent varicose veins (43%, P < 0.001) compared with that in ‘normal’ limbs. Among patients with non-thrombotic DVI the most common patterns were isolated reflux in the superficial femoral vein (51%), and combined reflux in the superficial and deep femoral veins (44%). Isolated reflux in the deep femoral vein occured in 5%. Complete visualization of the deep femoral vein is a new diagnostic sign that strongly correlates ( P < 0.001) with reflux in this vein. femoropopliteal and isolated popliteal reflux caused abnormal venous pressure values even in asymptomatic patients. Incompetence of calf perforators strongly influenced these values. Varicose vein surgery in limbs with a strong calf muscle pump resulted in significant improvement in venous pressure. The long-term results of valvuloplasty were good in 67% of the extremities. A significant improvement in venous pressure was observed in limbs with competent deep femoral vein valves, which suggests that the functional state of this vein is of great haemodynamic importance.
Superficial Femoral Vein Valve Repair with Limited Anterior Plication
Authors: Belcaro G. , Ricci A. , Laurora G. , Cesarone M. R. , De Sanctis M. T. , Incandela L. 
Published: January 2017

Objective: To evaluate the effects after 3 years of a new surgical technique, limited anterior plication (LAP) of the superficial femoral vein. Design: Patients with venous hypertension resulting from deep and superficial venous incompetence were randomized into two treatment groups. Setting: Angiology and Vascular Surgery, Pierangeli Clinic, Pescara, and Cardiovascular Institute, Chieti University, Italy. Patients: Both groups were treated with superficial vein surgery. Group 2 was also treated with LAP. Interventions: Valvuloplasty of the superficial femoral vein was performed with plication of the anterior vein wall after limited dissection of the vein. Main outcome measures: During a 3-year follow-up results were evaluated with colour duplex and ambulatory venous pressure (AVP) measurements. Endpoints were AVP, refilling time (RT), number of incompetent venous sites, presence/absence of the reflux at the superficial femoral vein and the diameter of the vein. Results: No complications were observed. All femoral veins treated with LAP were competent at 36 months. Significantly lower AVP and longer RT were observed in the LAP group. The number of incompetent venous sites was lower in both groups. The average diameter of the vein was higher in Group 1. Conclusions: In selected subjects – moderate deep venous incompetence, functional cusps, incompetence mainly due to relative enlargement of the vein – LAP may be an alternative to external valvuloplasty.