A 'non-blind' randomized hand washing intervention study was conducted in a low socioeconomic community in Rangoon to determine if hand washing by 494 children under 5 years old and their mothers could reduce the incidence of diarrhoea and dysentery in these children. Children and mothers in the intervention group were asked to wash their hands after defaecation and before preparing or eating their 3 main meals; 2 bars of plain soap were provided. The control group was left to follow customary practice. Diarrhoea and dysentery incidences in the 2 groups were monitored during 4 months by comparing the incidence density ratios (IDR). The diarrhoeal incidence among the children in the hand washing households was significantly lower than that among those in the control households (IDR = 0.70, 95% confidence interval (CI) = 0.54-0.92). For dysentery incidence, although there was a 40% reduction (IDR = 0.58, 95% CI = 0.22-1.55) in the children under 2 years, there seemed to be no impact in older children (IDR = 1.2, 95% CI = 0.52-2.80). The study indicates that hand washing is effective in reducing the morbidity from diarrhoea and dysentery.
Errors in a trauma registry database cause invalid frequencies, rates, time estimates and statistical measures and affect QA/PI in trauma care. Every functioning trauma registry should develop an on-going program for DV.
The present review will examine epidemiological perspectives and be confined mainly to the results of those field studies published since 1975 in order to provide concrete scientific evidence of the effect of ascariasis on childhood malnutrition, particularly on growth. The field studies were done in many developing countries from Africa, Asia and Latin America, using cross-sectional and intervention studies in which anthelmintics were employed, with different dosing frequency and follow-up periods ranging from 33 days to 2 years. In general, a better nutritional status in terms of growth, lactose tolerance, vitamins A and C, and albumin levels were observed among Ascaris-free or treated than among Ascaris-infected or untreated children even in cross-sectional or non-randomized studies. More importantly, the improvement in weight or height after chemotherapeutic treatment was found to be significant particularly in those randomized controlled studies with an initially high prevalence of ascariasis and malnutrition, a low prevalence of other intestinal parasites, repetitive and regular treatments of children with tetramisole, levamisole or pyrantel, within a period of 12 or 24 months. Reasons for failures to detect improved growth in some studies are provided. This review strongly indicates that A. lumbricoides infection definitely retards childhood growth.
The purpose of this study was to assess the impact a free, on-site influenza immunization program could have on attendance in Title 1 schools. Four Title 1 elementary schools participated in the study. Students at 2 schools were offered free FluMist immunizations on site, and students at 2 control schools were not. Compliance on receiving FluMist was measured on the percentage of students participating after evaluating for medical exclusions. Documentation on the reason for absences at all 4 schools included self- or parent-reported influenza. Attendance rates for the year also were compared with the previous year for all 4 schools. A comparison was done of total days absent versus total days enrolled between schools receiving FluMist and schools not receiving the vaccine. Despite the fact that FluMist is a new vaccine and is not required for children, 57% of those medically eligible to receive it had parental permission and received the vaccine. The 2 schools receiving FluMist increased their attendance rates from 95.3% and 93.9% to 96.1% and 95.8%. Previously, the comparison schools each had a 94.6% attendance rate; one fell to 94.4% and the other rose very slightly to 94.7%. The differences in self- or parent-reported influenza absences were not significant. However, the difference in days absent between individual vaccinated and nonvaccinated schools was statistically significant.
Nonreconstructed computerized tomography detected fractures of the thoracolumbar spine more accurately than plain radiographs did and is recommended for the diagnosis of thoracolumbar spine fractures in acute trauma patients with altered mental status. Reconstructions do not need to be ordered unless an abnormality that is found on the nonreconstructed computerized tomographic scan needs additional elucidation.
Discharge to a nursing home (NH) because of chronic debilitating diseases or old age is generally a terminal event. The purpose of this study was to evaluate the NH outcome of senior citizens injured in motor vehicle crashes (MVC) discharged to a NH. From 2000 through 2004, 157 patients 75 years and older were admitted to the hospital for MVC. Of these, 32 patients were discharged to a NH, and these patients or their proxies were interviewed by telephone in June 2005 to request information as to driving status before and after the MVC, feeding, expression, and locomotion status, and/or date of death. After discharged from the NH, 72 per cent (23/32) of the patients lived at home, 52.2 per cent (12/23) among the drivers returned to drive, and those with functional impairments (excluding the five NH deaths and four still remaining in a NH) at the time of hospital discharge had 100 per cent or partial improvement in three functional independent measures at the time of the interview: 5 cases in feeding, 2 in expression, and 20 in locomotion. Eleven of the 20 individuals dependent or partially dependent in locomotion status were fully independent. The majority of the senior patients discharged to a NH after a MVC returned to a normal life by going back home, driving again, and regaining functional activities after NH discharge. Discharge to a NH for elderly MVC trauma patients may be regarded as a stepping-stone to independent living rather than a final resting place.
A longitudinal study on reinfection with Ascaris lumbricoides was continued on a random sample of 50% of the infected population following a horizontal cross-sectional study in Okpo village, near Rangoon. The study sample was again randomly divided into two subsamples, the six-month interval worming group and the 12-month interval worming group. Microscopic examination of stool for Ascaris eggs on the 7th day and 30th day, combined with counting eggs and worming with levamisole, were carried out at two successive six-month intervals on the first subsample. Stools were examined and eggs counted on the 7th day and then monthly up to 12 months, followed by worming, in the second subsample. The worms expelled in the first 72 hours after treatment were counted. The findings over a 12-month follow-up period after one treatment included: mean monthly incidence of 20%, higher and more rapid return to previous prevalence and intensity of infection in children or 'wormy' persons than in adults or 'non-wormy' persons. Six-monthly chemotherapy definitely reduced intensity of infection in the children and adults whereas 12-monthly treatment lowered intensity in adults only. Predisposition to acquisition of high or low intensity of infection was also observed. Other findings and the implications of this study for strategies for control of ascariasis are discussed.
The rate of missed injuries remained relatively constant over the past 10 years at our institution. More severely injured patients are more likely to have missed injuries. Special attention to the lower extremities of the younger trauma patient may be warranted.
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