A Win-Win for Sport and Exercise Medicine and Primary Care: A Qualitative Case Study of the Added Competence Model in Canada

OBJECTIVE

To understand the unique impacts of the College of Family Physicians of Canada's (CFPC) Certificate of Added Competence (CAC) in Sport and Exercise Medicine (SEM) on the delivery of comprehensive care in Canada.

DESIGN

Secondary analysis of qualitative interview data collected during a multiple case study of the impacts of the CAC program in Canada.

SETTING

Six cases purposively sampled from across Canada. Each case was bound by a collective of healthcare providers who work with a defined group of patients.

PARTICIPANTS

Across the cases, 48 individuals participated, including SEM and other enhanced skill family physicians, generalist family physicians, residents, specialists, and administrative staff.

MAIN OUTCOME MEASURES

Qualitative descriptions of the impacts of the SEM certificate on comprehensive care provision in Canada.

RESULTS

SEM certificate holders experience enhanced well-being and professional satisfaction while also benefitting comprehensive care in communities in numerous ways. That SEM certificate holders may prioritize professional interests over community healthcare needs was identified as a potential drawback. Athletes and physically active individuals have specific healthcare needs, and may constitute a significant critical mass to be considered a community unto themselves.

CONCLUSIONS

The SEM certificates impact healthcare positively when holders work in collaborative models that are well aligned with local community needs. Expanding the awareness of the scope of SEM and advocacy for adequate remuneration for these services have the potential to enhance SEM contributions to comprehensive family medicine in Canada.

Dengue in parts of the Guinea Savannah region of Nigeria and the risk of increased transmission

BACKGROUND

Dengue virus (DENV) is spreading to parts of the world where it had not been previously reported. Increased international travel has led to intercontinental importation of dengue by visitors returning from countries in sub-Saharan Africa. Although dengue is well documented in the rain forest region of Nigeria, there is a dearth of information in the Guinea Savannah region, which is a major transit point for local and international visitors in the most populous nation in Africa. We provide preliminary evidence of dengue activity in the Guinea Savannah and highlight the risk factors.

METHODS

Blood was collected from a cross-section of 200 patients attending four hospitals in Anyigba, Kogi State. Anti-dengue antibody was identified using DENV immunoglobulin G (IgG) immunoassays. Questionnaires were used to obtain sociodemographic variables and risk factors. Data were analysed with SPSS version 16.0 for Windows.

RESULTS

Forty-two (20.5%) participants had anti-DENV IgG antibodies. Persons within the 45-59 y age group were more seropositive, with a rate of 35%. Males were more seropositive compared with females. Marriage, formal education, involvement in business activities and the presence of grasses around homes were associated with higher IgG seropositivity. The presence of open water containers around human dwellings and a lack of mosquito net use are predisposing factors.

CONCLUSIONS

This study identified past exposure to DENV among people in Anyigba, located in the Guinea Savannah region. Proper diagnosis of febrile episodes is required to improve case management and curtail off-target treatment. The high rate of previous exposure of patients to dengue indicates the need to strengthen vector control and dengue surveillance programs.

A preliminary study on humic-like substances in particulate matter in Malaysia influenced by Indonesian peatland fires

In this paper, ambient total suspended particulates (TSP) with a focus on humic-like substances (HULIS) are characterized based on intensive ground-based field samplings collected in Malaysia during non-haze and haze periods caused by peatland fires on the Indonesian island of Sumatra. Furthermore, concentrations of water-soluble organic carbon (WSOC) and carbon content of HULIS (HULIS-C) were determined, and fluorescence spectra of the HULIS samples were recorded by excitation emission matrix (EEM) fluorescence spectroscopy. The concentrations of WSOC and HULIS-C over the entire period ranged from 4.1 to 24 and 1.3 to 18 μgC m^-3, respectively. The concentrations of WSOC and HULIS-C during the peatland fire-induced strong haze periods were over 4.3 and 6.1 times higher, respectively, than the average values recorded during the non-haze periods. Even during the light haze periods, the concentrations of WSOC and HULIS-C were significantly higher than their averages during the non-haze periods. These results indicate that peatland fires induce high concentrations of WSOC, particularly HULIS-C, in ambient TSP at receptor sites. EEM fluorescence spectra identified fulvic-like fluorophores at the highest intensity level in the EEM fluorescence spectra of the haze samples. A peak at excitation/emission (Ex/Em) ≈ (290-330)/(375-425) nm is also observed at high intensity, though this peak is normally associated with marine humic-like fluorophores. It is shown that a peak at Ex/Em ≈ (290-330)/(375-425) nm is not derived from marine sources only; furthermore, peatland fires are shown to be important contributors to HULIS around this peak.

[Fulminant acute kidney injury after cholecystectomy in a 45-year-old female patient]

A cholecystectomy was carried out on a 45-year-old female patient with fever, myalgia and right upper abdominal pain because of a suspected cholecystitis. Postoperatively acute kidney injury occurred. A comprehensive medical history taken later revealed a presumed occupational contact to rodents. Serological testing detected a recent infection with Dobrava-Belgrade hantavirus. The kidney function normalized with supportive therapeutic measures. Hantavirus infection should be considered in the differential diagnosis of acute kidney injury combined with fever, myalgia and abdominal pain.

Clinicopathological Study of Enterocutaneous Fistula in Mymensingh Medical College Hospital

Enterocutaneous fistulae are a major catastrophe to the patients and surgeons and it still has high incidence of morbidity and mortality and their management remains a big challenge. Enterocutaneous fistula presents the surgeon with challenges of metabolic disorders and extensive sepsis. Total management of an intestinal fistula requires skill in nutritional support, stoma therapy, elimination of sepsis, well timed and well carried out surgery. Postoperative enterocutaneous fistulae account for approximately 80% of enterocutaneous fistulae. The majority of the intestinal fistula (75-85%) is iatrogenic occurring in the postoperative period following anastomotic dehiscence. They arise following emergency abdominal surgery for intestinal obstruction, inflammatory bowel disease or cancers. Protein calorie malnutrition alters the patients immune response, inflammatory reactions and tissue regenerations, all of which are essential for wound repair. The present study is an effort to highlight the incidence of enterocutaneous fistula after emergency and elective resection and anastomosis of gut with discussion over recent trends and developments in its management and compare with other studies. Objectives of the study are to determine the various clinicopathological features and management protocol of enterocutaneous fistula. There are recent advances in nutritional support. This descriptive type of cross-sectional study was carried out in the Department of Surgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh from October 2010 to September 2011. Total 42 cases of enterocutaneous fistulae were selected purposively. Enterocutaneous fistulae are more common in patients of low economic condition. Enterocutaneous fistulae are more common after emergency abdominal surgery. Spontaneous closure occurred in 17(40.48%) cases and surgery needed in 25(59.52%) cases. Of them 20(80.00%) were healed and 5(20.00%) were expired. In spite of improvement in the management protocol of enterocutaneous fistula, there is still high unacceptable morbidity and mortality rate. Total parenteral nutrition (TPN) is not available and very costly, and health care facilities are also limited in our country. Patients with enterocutaneous fistula require fluid, electrolytes and nutritional support. Anaemia, dehydration, electrolytes imbalance should be corrected prior to abdominal surgery if possible. Surgical treatment for enterocutaneous fistula should be performed only after failure of conservative treatment of more than 12 weeks.

Prosthodontic management of maxillofacial cases: a case series

Maxillofacial prosthetics is an important and recognized sub-discipline of prosthodontics that forms a key component of postgraduate training programmes. General dentists have a role to play in the management of maxillofacial defect patients even though treatment usually requires a multidisciplinary approach in an institutional environment. Maxillofacial prosthetic cases frequently present with complex histories but simple patient goals. The conservatively managed implant-retained auricular prosthesis, speech aid prosthesis and orbital prosthesis cases described in this report were completed in a postgraduate clinical residency program and highlight the intrinsic complexities, challenges and ultimately satisfaction related to cases of this nature.

Characterization of spatial and temporal variability in hydrochemistry of Johor Straits, Malaysia

Characterization of hydrochemistry changes in Johor Straits within 5 years of monitoring works was successfully carried out. Water quality data sets (27 stations and 19 parameters) collected in this area were interpreted subject to multivariate statistical analysis. Cluster analysis grouped all the stations into four clusters ((Dlink/Dmax) × 100<90) and two clusters ((Dlink/Dmax) × 100<80) for site and period similarities. Principal component analysis rendered six significant components (eigenvalue>1) that explained 82.6% of the total variance of the data set. Classification matrix of discriminant analysis assigned 88.9-92.6% and 83.3-100% correctness in spatial and temporal variability, respectively. Times series analysis then confirmed that only four parameters were not significant over time change. Therefore, it is imperative that the environmental impact of reclamation and dredging works, municipal or industrial discharge, marine aquaculture and shipping activities in this area be effectively controlled and managed.

Transboundary smoke haze pollution in Malaysia: inpatient health impacts and economic valuation

This study assessed the economic value of health impacts of transboundary smoke haze pollution in Kuala Lumpur and adjacent areas in the state of Selangor, Malaysia. Daily inpatient data from 2005, 2006, 2008, and 2009 for 14 haze-related illnesses were collected from four hospitals. On average, there were 19 hazy days each year during which the air pollution levels were within the Lower Moderate to Hazardous categories. No seasonal variation in inpatient cases was observed. A smoke haze occurrence was associated with an increase in inpatient cases by 2.4 per 10,000 populations each year, representing an increase of 31 percent from normal days. The average annual economic loss due to the inpatient health impact of haze was valued at MYR273,000 ($91,000 USD).

Which is the optimal depression rating scale for psychiatrists? a diagnostic validity comparison of hospital anxiety and depression scale (HADS) and psychiatric judgement against the MINI

Introduction

Ustun et al estimated that depression is the fourth leading cause of global disease burden. The burden of depression on the healthcare system is equally significant with an estimated US annual cost of approximately $26 billion (1990). In a European epidemiologic study of mental disorders involving six countries, major depression was the single most common disorder assessed, with a 12-month prevalence of 3.9%.

Objectives

Our aim was to find the optimal tool with the highest accuracy in comparison to the (MINI) for depression.

Aims

We aimed to find the depression rating scale with the highest accuracy when applied by psychiatrists in Iraq.

Methods

We recruited 400 subjects; The (MINI) was used as a gold standard to define the presence of major depression according to DSMIV criteria stratified into 200 patients with primary depression and 200 non-depressed subjects in Kurdistan region of Iraq. We examined the symptoms of depression using the Hospital Anxiety and Depression Scale (HADS) and Clinical Global Impression (CGI). Interviews were performed by three psychiatrists who were blinded to the group allocations. ROC curve analysis was used.

Results

Both HADS and CGI performed with high accuracy compared with the MINI interview for DSMIV major depression. Clinicians using the CGI were accurate in their clinical judgement with sensitivity of 97% and specificity of 99%.

Conclusions

We found the psychiatrist's opinion alone was very accurate with higher sensitivity and specificity than the HADS and therefore it is unclear from our sample if questionnaires would help clinicians in their diagnoses.

Thoracolumbar fracture--dislocation results of surgical treatment

Fifteen cases of unstable fracture-dislocation of the thoracolumbar spine have been treated by open reduction, short segment transpedicular fixation and fusion in Universiti Unit, Kuala Lumpur Hospital from January 1994 until December 1997. Twelve male and three female patients were injured; their age ranged from 18 to 45 years. Five fracture-dislocations occurred in the lower thoracic spine (T8 to T11), eight at the thoracolumbar junction (T12 to L2) and two in the lumbar spine (L3 to L5). All the patients had neurological deficit. Seven patients with incomplete or cauda equina lesions regained some neural function, while all eight with complete lesions remained unchanged. Ten of the fifteen cases were grossly unstable and translated beyond 50% of the width of the spinal column. At the time of follow up (more than one year in all patients), no loss of reduction or of fixation was noted in any patient. Solid fusion was achieved in all patients. The advantages of this method of treatment include stable fixation, with maintenance of sagittal and coronal spinal alignments, to allow early rehabilitation.

Methylene chloride poisoning in a cabinet worker

More than a million workers are at risk for methylene chloride exposure. Aerosol sprays and paint stripping may also cause significant nonoccupational exposures. After methylene chloride inhalation, significant amounts of carbon monoxide are formed in vivo as a metabolic by-product. Poisoning predominantly affects the central nervous system and results from both carboxyhemoglobin formation and direct solvent-related narcosis. In this report, we describe a case of methylene chloride intoxication probably complicated by exogenous carbon monoxide exposure. The worker's presentation of intermittent headaches was consistent with both methylene chloride intoxication and carbon monoxide poisoning. The exposures and symptoms were corroborated by elevated carboxyhemoglobin saturations and a workplace inspection that documented significant exposures to both methylene chloride and carbon monoxide. When both carbon monoxide and methylene chloride are inhaled, additional carboxyhemoglobin formation is expected. Preventive efforts should include education, air monitoring, and periodic carboxyhemoglobin determinations. Methylene chloride should never be used in enclosed or poorly ventilated areas because of the well-documented dangers of loss of consciousness and death.

A double blind comparison of zuclopenthixol acetate with haloperidol in the management of acutely disturbed schizophrenics

The aim of this study was to evaluate the efficacy and side effects of zuclopenthixol acetate compared with haloperidol in the management of the acutely disturbed schizophrenic patient. Suitable subjects diagnosed as having schizophreniform disorder or acute exacerbation of schizophrenia admitted to the psychiatric wards Hospital Kuala Lumpur were randomised to receive either zuclopenthixol acetate or haloperidol. They were rated blind for three consecutive days using the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and UKU Side Effects Scale. Apart from repeat injections of the same medication, no other anti-psychotic was given for the duration of the study. 50 subjects entered the study of which 44 completed. 23 were given zuclopenthixol acetate and 21 haloperidol. Both groups significantly reduced BPRS and CGI scores on all 3 days compared to the initial rating (p < 0.001). There was however no difference between the zuclopenthixol acetate and haloperidol group scores on all days (p > 0.05). More subjects on haloperidol than zuclopenthixol required more than 1 injection during the study. Both groups had minimal side effects. Zuclopenthixol acetate was effective in the management of the acutely disturbed schizophrenic.

Adolescent contraceptive use and its determinants in Bangladesh: evidence from Bangladesh Fertility Survey 1989

This study is concerned with contraceptive use among the currently married adolescents in Bangladesh utilizing the 1989 Bangladesh Fertility Survey (BFS) data. The study analyzes the factors affecting the current use of contraception among the adolescents through bivariate and multivariate logistic regression analysis. The results indicate that although adolescents have almost universal knowledge about contraceptive methods, only 15 percent are currently using any method of contraception. The corresponding figures for the adults and for the nation as a whole are 34.4 percent and 31.4 percent, respectively. Among the individual methods currently used by the adolescents, the pill appears as the most popular method, followed by safe period. A substantial proportion of the adolescents were found to rely on the traditional methods of contraception. Among the socio-economic variables (as revealed by the logistic regression analysis), respondents' education, participation in the family planning decision, visit by family planning workers, region of residence, husband's occupation and possession of electricity in the household appear as the most significant factors determining the current use of contraception among the adolescents.