Parental Perceptions Regarding the Impact of Housing on Child Health

Introduction Childhood poverty has life-long adverse impacts. We aimed to assess perceptions of parents of a cohort of children attending a paediatric emergency department regarding the impact of their housing on their child and family Methods From 01/11/2020 - 08/01/2021 a cross-sectional study was performed in a paediatric emergency department in Dublin Results Of 312 parents who completed a questionnaire, 4.5% (n = 14) reported themselves to be homeless. Homeless children were less likely to be registered with general practitioners (78.6% vs. 97.5%, p = .009) or be fully vaccinated (71.4% vs. 92.4%, p = .024). Homeless parents were more likely to feel unsafe at home (35.7% vs. 3.4%, p <.001), and to report that their housing negatively impacted their child's education (58.3% vs 10.7%, p <.001), physical health (45.5% vs 11.7, p = .007), and mental health (61.5% vs 12.6%, p <.001). Ten percent of non-homeless parents were concerned about losing their home. A lack of landlord permission to install child safety measures in the home was reported by 28% of all parents. Conclusion Homeless parents were more likely to report that their living situation negatively impacted their child's play, development, education, safety, and health.

Recumbent Exercise Bicycle for Low-Impact Rehabilitation of Obese Individuals

It is often difficult for persons who are extremely overweight to find exercise systems that are accessible and safe to use. Seating is required to handle heavier loads of up to 500 lbs. and provide safe access to the exercise unit. Additionally, the exercise should not cause additional pain or possible damage if the person needs to suddenly stop. A multidisciplinary team of undergraduate engineers participated in a training course to interview a non-technical customer to determine design requirements and then underwent a rigorous design process to implement the best solution. Mechanical analysis was performed to determine the best solution for the concept, materials, and resistance. An exercise machine with a rotating chair was selected as the best solution. The chair rotates 90 degrees so that the user can sit down without having to step onto the machine. Once the user sits, the chair can then rotate 90 degrees until the chair is in the exercise position; in either position the chair locks into position for stability. This particular concept uses a bicyle exercise. This exercise minimizes impact on the knees, which is a safety issue for patients with knee problems. A sitting position for this exercise eliminates the stability issue raised with a standing exercise, where there is worry of falling. This exercise is beneficial for cardiovascular exercise. Resistance is implemented using a magnet. Fluid resistance and fly-wheel resistance would create too much momentum which was not desired by the customer. Electrical analysis was performed to determine the best method to sense heart rate, speed, and computer interface. Wired handles were selected to monitor the heart rate. These are hand held and are much easier to use than a chest strap. An optical sensor was used to sense speed. It was placed near the center of the wheel and rotations were indicated by a tab to break the connection in the sensor. This method was selected over a Hall effect sensor because it is a much simpler sensing method that does not require an addition magnetic component that is not too accurate a low speeds. The computer interface was a Motorola HC12s since it had the necessary I/O interfaces and was low cost. A custom interface was created with seven segment displays to show the heart rate and time of exercise. The system was then developed, tested, and delivered to the customer for use. This project was supported by Grant No. 0607883 from the National Science Foundation.

“IT’S MORE THAN A PILL DROP”: ADHERENCE SUPPORT AND THE CLINICAL GAZE IN INNER CITY HOME-BASED HIV CARE

Background:Home-based HIV care has been identified as means of improving access to HIV care and reducing HIV-related stigma, while easing overload in facility-based care and providing cost effective community-based social supports. Few evaluations, however, focus on the impactof barriers such as homelessness, imprisonment and substance abuse to the continuity of this model of health care provision. This paper examines the challenges, strategies, and outcomes of a long-standing home-based HIV nursingprogram from a Foucauldian analytic perspective. Methods: Findings are presented from the evaluation of a home care nursing team providing HIV care to unstably housed individuals in Vancouver’s inner city. Employing ethnographic methodology, participant observation was conducted over nine months, along with serial open-ended qualitative interviews with the nursing team (n=4) and home care clients (n=16). Interviews were audio recorded and transcribed; an interpretive thematic analysis of field notes and interview transcripts was conducted. Results: Although adherence to antiretroviral therapy was consistent over the study course, men and women’s responses to care varied over time. Nurses who were sensitive to the ways in which enhanced surveillance within the private sphere of participants’ lives was cause for resistance to care employed a number of strategies to maintain these relationships. Variability among nurses regarding local (i.e. street) knowledge, along with understandings of what constitutes appropriate supportive measures, also impacted participants’ responses to care. Conclusions: The type and extent of support services is continually negotiated between nurses and participants, creating a potential source of tension between the guiding of health-related decisions and participants’ constitution of themselves as autonomous. Foucault’s concept of governmentality is applicable here, and may elucidate how norms, capacities and subjectivities are mutually created through its processes. The findings support an understanding of autonomy that is interpersonally, as well as institutionally, relational. Successful programming requires careful attention to the everyday experiences of participants, facilitated by continuity of providers andmentorship for newer nurses engaging in home-based HIV care. SuzeBerkhout is supported by the Canadian Institutes for Health Research, The Michael Smith Foundation for Health Research, Providence Health, and Vancouver Coastal Health Research Institute.

Effects of intra-uterine growth restriction on the control of breathing and lung development after birth

1. Low birthweight is now recognized as an important risk factor for early postnatal respiratory illness and it is becoming evident that low birthweight can increase the risk for airway dysfunction in children and adults. Our studies have been aimed at determining how low birthweight, resulting from intra-uterine growth restriction (IUGR), affects the control of breathing and the structural and functional development of the lung. 2. We have measured ventilatory responsiveness to progressive hypoxia and progressive hypercapnia during the first weeks after birth in postnatal lambs in which IUGR was induced by chronic placental insufficiency. It was found that the postnatal increase in ventilatory sensitivity to hypoxia observed in control lambs was diminished in low birthweight lambs; in contrast, the sensitivity to hypercapnia was not affected. In other studies, we found that IUGR caused by maternal anaemia led to elevated CO2 levels during sleep and wakefulness. 3. Our findings suggest that the prenatal development of the brain-stem or respiratory chemoreceptors may be affected by intra-uterine factors associated with IUGR, such as foetal hypoxaemia or hypoglycaemia. It is also possible that the structure of respiratory muscles and, hence, their ability to maintain a high level of ventilation may be affected by IUGR. 4. Recently, we studied the influence of IUGR on foetal lung development, in particular its effects on foetal lung liquid, a major determinant of lung growth, as well as alveolar structure and pulmonary surfactant. Lung liquid secretion and volume, in relation to bodyweight, were unaffected; however, there was evidence of structural and functional immaturity in the lungs. In foetuses exposed to IUGR, the air-blood barrier was thicker and, after birth, the diffusing capacity of the lungs for carbon monoxide was lower. In contrast, surfactant protein gene expression was enhanced, particularly in foetuses with high levels of circulating cortisol. 5. Further studies are needed to characterize the effects of specific types of prenatal compromise on postnatal control of ventilation and lung function, to determine mechanisms underlying these effects and to determine the capacity for postnatal recovery.

Inpatient Group Psychotherapy: The Role of the Staff Nurse

Inpatient groups are inherently different from outpatient groups and require modification in approach. Patients' needs, staff interests and expertise, and the needs of the health care system are major driving forces in the development of inpatient groups. A co-therapy model helps to achieve a balance between skills and abilities of the therapist.

Use of goal attainment scaling in measuring clinically important change in cognitive rehabilitation patients

Measuring the effectiveness of cognitive rehabilitation programs poses both conceptual and practical challenges. We compared several standardized outcome measures with goal attainment scaling (GAS) to assess their sensitivity to changes in health status in patients undergoing cognitive rehabilitation. GAS is a measurement approach that accommodates multiple individual patient goals, and has a scoring system which allows for comparisons between patients. Forty-four patients were evaluated. GAS yielded a mean 4.4 goals per patient. The mean gain in the GAS score was compared with the change in the Rappaport Disability Rating Scale, the Kohlman Evaluation of Daily Living Skills, the Milwaukee Evaluation of Daily Living, the Klein-Bell elimination scale and mobility scale, the Instrumental Activities of Daily Living Scale, and the Spitzer Quality of Life Index. Using a relative efficiency statistic, GAS proved more responsive than any other measure. The effect size statistic also demonstrated greater responsiveness to change with GAS compared with standard measures. GAS shows promise as a responsive measure in cognitive rehabilitation. This study replicates a similar study of GAS in frail elderly patients, suggesting that individualized measures may have broad merit in evaluating rehabilitation programs.

Congenital hypothyroidism: the Riyadh Military Hospital experience

OBJECTIVE

We aimed to find out the incidence of primary congenital hypothyroidism (CH) among infants born within the Riyadh Al-Kharj Hospital Programme in addition to early detection and treatment of these infants.

DESIGN

All babies born within the Riyadh Al-Kharj Hospital Programme were screened by cord blood TSH. Blood spot TSH were done in the majority of infants between 2 and 5 days after birth. All suspected cases were recalled for confirmatory tests. 123I thyroid scan and X-ray of the knee and maternal blood for thyroid antibodies were done for confirmed cases.

MEASUREMENTS

A cut off TSH level of 30 mIU/l for cord blood and 25 mIU/l for spot blood were used. All samples were assayed by immunoassay methods.

RESULTS

44,778 (99.4% of the total births) infants were screened. Twenty-five cases were detected, four of which were excluded. The incidence of primary congenital hypothyroidism was 1/2096. Five cases were missed on the initial screen. Eight out of 17 children who had 123I thyroid scan were found to have dyshormonogenesis. Associated malformation and diseases were diagnosed in 42.85%. Two had chromosomal anomalies; ring chromosome 9 has not been previously reported in association with congenital hypothyroidism.

CONCLUSION

The incidence of congenital hypothyroidism, dyshormonogenesis and the associated malformations and diseases are higher than those reported in the literature. Cord blood as a screening method is associated with a significant number of missed cases.

Staying Well

1. Friends were rated as the most important factor in assisting former psychiatric patients to avoid rehospitalization. 2. When respondents were asked to comment on rehospitalization in their own words, the most frequent responses dealt with factors related to keeping active, developing a healthy lifestyle and positive self-image, and accepting their illness. 3. Self-help groups, community health workers, and community nurses were rated as the least beneficial in preventing rehospitalization.

Intensive care for respiratory failure in Guillain-Barré syndrome

Although relatively uncommon, Guillain-Barré syndrome remains the most frequent cause of sudden weakness in persons under the age of 40 years. While most patients enjoy spontaneous resolution of their neurologic deficits, death still occurs in some individuals who suffer secondary complications from profound respiratory muscle weakness. This review of patients with ascending paralysis who required intubation and mechanical ventilation underscores that the major factors which contribute to death and morbidity can be anticipated and largely avoided using a vigilant multidisciplinary approach.

Outpatient in vitro fertilization using transvaginal ultrasound-guided oocyte retrieval

Of 80 patients who initiated in vitro fertilization cycles in an integrated outpatient facility, 61 had oocyte retrievals performed under local anesthesia with ultrasound-guided transvaginal aspiration of ovarian follicles. Ten patients conceived, all in the group of 49 who had human chorionic gonadotropin (hCG)-timed retrievals. Our results indicate that in vitro fertilization can be performed to a high standard with this method, with excellent patient acceptance and reduced cost without general anesthesia, laparoscopy, or in-hospital setting.

Stability of four steroids in lyophilised human serum

The stability of a preparation of lyophilised serum and its suitability for use as a reference material for routine assays of cortisol, oestradiol, and progesterone have been studied in four laboratories with a variety of assay systems. Cortisol and oestradiol were also measured by gas chromatography-mass spectrometry. The lyophilised serum was suitable for use in all routine and reference assay methods examined, with between-method variability no greater than that for frozen serum pools. The concentrations of cortisol, oestradiol, and progesterone were predicted by accelerated degradation studies to decline by 0.01% per annum if the preparations were to be stored at --20 degrees C. The testosterone content of the preparation, determined in one laboratory, provided no evidence for degradation. The preparation can be shipped for use at ambient temperature without deleterious effect.