Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project / Promover una alianza entre la atención primaria y las organizaciones comunitarias para aumentar las pruebas de detección de cáncer colorrectal: el proyecto HAPPI

Abstract: Objective: The Healthy Aging Partnerships in Preven tion Initiative (HAPPI) aims to increase the use of clinical preventive services (CPS) among underserved Latinos and African Americans in South Los Angeles who are 50+ years old. Materials and methods: HAPPI uses an evidence-based model, SPARC, to leverage existing resources and link community resources. HAPPI's multi-sectoral partnerships include local non-governmental organizations (NGOs), community health centers (CHCs), aging and public health agencies serving the City and County of Los Angeles, and a university. Activities include CHC capacity assessment and training, and community capacity-building that included a small grants program. Results: We engaged five CHCs in quality improvement activities and eight NGOs in networking and programming to increase awareness and receipt of CPS. We discuss barriers and facilitators including the success of trainings conducted with CHC providers and NGO re presentatives. Conclusion: Multi-sectoral collaborations hold promise for increasing awareness and use of CPS in underserved communities.

Resumen: Objetivo: HAPPI se propone aumentar el uso de servicios clínicos preventivos (SCP) en personas mayores de 50 años en Los Ángeles. Material y métodos: HAPPI es una colaboración intersectorial e incluye organizaciones no gu bernamentales (ONG) locales, centros de salud comunitarios (CSC), centros de servicios para personas mayores, agencias de salud pública que dan servicio a la ciudad y al condado de Los Ángeles, y una universidad pública para movilizar recur sos comunitarios y promover lazos entre las asociaciones. Sus actividades incluyen asesorar y aumentar la capacitación de CSC y la comunidad, además de un programa de becas. Resultados: Se colaboró con cinco CSC para la mejora de calidad y con ocho ONG para abrir conciencia de los SCP. Se presentaron barreras y facilitadores incluyendo el éxito de las enseñanzas con proveedores de CSC y representantes de las ONG. Conclusión: Las colaboraciones multi-sectoriales son prometedoras para amplificar conciencia del uso de SCP en personas mayores.

Senior Managed Care System for Hip Fracture in the United States

BACKGROUND: It is debatable whether a managed care model would affect the quality of care and length of hospital stay in the treatment of hip fractures in elderly patients. METHODS: This prospective study was undertaken to determine whether or not a managed care critical pathway tool shortened hospital stay in a group of 102 senior patients with fractures of the hip during follow-up. We compared our study findings with two equivalent populations of senior hip fracture patients not treated using a critical care pathway concerning specific markers of quality. RESULTS: The managed care group had a 9% mortality rate, 95% return to prefracture living and 63% return to ambulatory status. The rates compared favorably with previous studies. The quality of care provided before and after the critical pathway was equivalent, while the post-pathway length of stay dropped 30%. CONCLUSIONS: The proposed care protocol is recommended to shorten hospital stay in elderly patients with hip fractures.

Cuatro cuestiones axiológicas de la epidemiología social para el monitoreo de la desigualdad en salud / Four axiological considerations in social epidemiology for the monitoring of health inequality

A medida que las agendas contemporáneas más relevantes de la salud pública mundial y regional se van alineando en sus componentes conceptuales y emerge más explícitamente el rol medular de la equidad como su principio constitutivo, va creciendo también el reconocimiento del valor estratégico del monitoreo de desigualdades sociales en salud como el instrumento por excelencia de la inteligencia sanitaria para juzgar objetivamente el progreso hacia la equidad en salud, pero también para dar cuenta de la acción sobre los determinantes sociales de la salud, el avance hacia el alcance progresivo de la universalidad en salud y el éxito de iniciativas intersectoriales con enfoque de salud en todas las políticas. Estas transformaciones acontecen en el marco de una cada vez más evidente transición paradigmática de la salud pública. Este ensayo plantea cuatro consideraciones axiológicas inherentes a-y esenciales para-la conceptualization e instrumentación de la medición y monitoreo de las desigualdades en salud: la ecoepidemiología como era emergente en la salud pública contemporánea, los determinantes de la salud como modelo de causalidad y núcleo del nuevo enfoque paradigmático, la relación entre jerarquía social y salud para entender el gradiente en salud, y la necesidad práctica de una clasificación socioeconómica para capturar la dimensión social de la determinación de la salud. Se plantea que estas cuatro cuestiones valorativas otorgan coherencia y racionalidad epidemiológicas al proceso de medición y monitoreo de las desigualdades en la salud y, por extensión, a la formulación de propuestas de política sanitaria en pro de la equidad.

As the conceptual components of the most important contemporary public health agendas at the global and regional levels are brought into alignment and as it becomes more clearly understood that equity is a constitutive principle of these agendas, there is also a growing awareness of the strategic value of monitoring social inequalities in health. This is the health intelligence tool par excellence, not only for objectively assessing progress towards achieving health equity, but also for reporting action on the social determinants of health, progress towards the attainment of health for all, and the success of intersectoral efforts that take a "health in all policies" approach. These transformations are taking place in the context of an increasingly evident paradigm shift in public health. This essay presents four axiological considerations inherent to-and essential for -conceptualizing and implementing ways to measure and monitor health inequalities: ecoepidemiology as an emerging field in contemporary public health; the determinants of health as the causal model and core of the new paradigm; the relationship between the social hierarchy and health to understand the health gradient; and the practical need for a socioeconomic classification system that captures the social dimension in the determinants of health. The essay argues that these four axiological considerations lend epidemiologic coherence and rationality to the process of measuring and monitoring health inequalities and, by extension, to the development of pro-equity health policy proposals.

Gene cloning, expression, and characterization of the Bacillus amyloliquefaciens PS35 lipase

Abstract Lipases are enzymes of immense industrial relevance, and, therefore, are being intensely investigated. In an attempt to characterize lipases at molecular level from novel sources, a lipase gene from Bacillus amyloliquefaciens PS35 was cloned, heterologously expressed in Escherichia coli DH5α cells and sequenced. It showed up to 98% homology with other lipase sequences in the NCBI database. The recombinant enzyme was then purified from E. coli culture, resulting in a 19.41-fold purification with 9.7% yield. It displayed a preference for long-chain para-nitrophenyl esters, a characteristic that is typical of true lipases. Its optimum pH and temperature were determined to be 8.0 and 40 °C, respectively. The half-lives were 2.0, 1.0 and 0.5 h at 50 °C, 60 °C and 70 °C, respectively. The metal ions K+ and Fe3+ enhanced the enzyme activity. The enzyme displayed substantial residual activity in the presence of various tested chemical modifiers, and interestingly, the organic solvents, such as n-hexane and toluene, also favored the enzyme activity. Thus, this study involves characterization of B. amyloliquefaciens lipase at molecular level. The key outcomes are novelty of the bacterial source and purification of the enzyme with desirable properties for industrial applications.

The ethics in qualitative health research: special considerations / A ética na pesquisa qualitativa em saúde: considerações especiais

AbstractA sound knowledge of the nature of qualitative research, along with an appreciation of some special ethical considerations, is needed for rigorous reviews to be conducted. The overall character of qualitative research is described with an emphasis on the tendency of qualitative researchers to explore sensitive topics using theoretically informed methods. A number of specific features of qualitative that require additional ethical attention and awareness are also examined including the following: 1) participants are frequently quite vulnerable and require protection because the data collection methods, such as in-depth interviews, can delve into personally and politically charged matters; 2) naturalistic observation can raise concerns regarding privacy and consent; 3) the potential for the identifiability of the results of this research may require extra efforts to maintain confidentiality. Ultimately, Reseach Ethics Committee members must be knowledgeable about qualitative approaches to be able to assess the potential harms and benefits in a protocol carefully. Without this knowledge gaining ethics approval can be overly difficult for researchers and the best practices for protecting human participants can be overlooked.

ResumoO caráter geral da pesquisa qualitativa é descrito com ênfase na tendência de pesquisadores qualitativos para explorar temas sensíveis, utilizando métodos teoricamente informados. Algumas características específicas de pesquisa qualitativa que requerem consciência e atenção ética adicional também são examinadas, incluindo as seguintes: 1) frequentemente os participantes são bastante vulneráveis e necessitam de proteção porque os métodos de coleta de dados, tais como entrevistas em profundidade, podem levar a uma profunda análise de questões repletas de aspectos pessoais e políticos; 2) a observação naturalística pode levantar questões específicas em matéria de privacidade e consentimento; 3) o potencial de que os resultados da pesquisa possibilitem a identificação dos participantes exige esforços adicionais para proteger a privacidade deles. Em última análise, os membros dos Comitês de Ética em Pesquisa (CEP) devem conhecer as abordagens qualitativas para avaliar cuidadosamente os potenciais danos e benefícios em um protocolo. Sem esse conhecimento, a aprovação ética pode ser excessivamente difícil para os pesquisadores e as melhores práticas para proteger os participantes podem ser negligenciadas.

When Does the Quality of Life Improve after Rotator Cuff Repair? / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to investigate when the quality of life improve after rotator cuff repair. MATERIALS AND METHODS: Eighty-five consecutive cases with rotator cuff repair were studied. Patients completed the visual analogue scale (VAS), University of California Los Angeles scale (UCLA), American Shoulder and Elbow Surgeon's scale (ASES), Korean Shoulder scale (KSS), and the World Health Organization Quality of Life Scale abbreviated version (WHOQOL-BREF) preoperatively and at postoperative 3, 6, and 12 months. For evaluation of serial recovery pattern, section I (preoperatively-postoperative 3 months), section II (postoperative 3 months-postoperative 6 months), and section III (postoperative 6 months-postoperative 12 months) were divided. RESULTS: The mean WHOQOL-BREF score was significantly improved from 58.8 preoperatively to 66.4 at postoperative 12 months, with improvement of VAS, ULCA, ASES, and KSS scores. On serial recovery pattern, all measurements in section I, VAS, UCLA, and KSS scores in section II, and UCLA score in section III, were significantly improved. Female sex had a negative effect on all outcome measurements at postoperative 12 months. CONCLUSION: Our results showed improvement of quality of life as well as reduced pain and increased function at 3 months after rotator cuff repair. Further recovery of clinical outcomes showed gradual progress until postoperative 12 months.

Menu labeling perception and health behaviors among immigrant and US born minority populations: Assessment in two Los Angeles public markets / Percepción del etiquetado de menúes y comportamientos de salud entre población minoritaria inmigrante y nacida en Estados Unidos: evaluación en dos mercados públicos de Los Ángeles

Objective. To analyze menu labeling perception and food choices/health behaviors in two Los Angeles public markets. Labels with food caloric content were displayed in the food court of one of these markets. Materials and methods. Bivarate means analyses compared the surveyed population by market and by nativity status. The main predictors of menu-labeling influence were identified in the sample from the market that displayed labels. A separate analysis investigated food choices/health behaviors among immigrant cohorts by time of US residence. Results. Reading labels when shopping was one of the main predictors associated with menu labeling influence. Longer-stayed immigrants were more likely to afford "balanced meals", but they were also more likely to eat in fast food restaurants and less likely to engage into moderate/intense physical activity. Conclusions. While nativity was not a significant predictor of menu labeling influence on food choices, our findings suggest food choices/behaviors convergence among immigrant and US-born populations.

Objetivo. Analizar la percepción del etiquetado de menús y la elección de alimentos/comportamientos de salud en dos mercados públicos de Los Ángeles. La información con el contenido calórico de los alimentos preparados estaba disponible en uno de los mercados. Material y métodos. El análisis bivarado compara la muestra por mercado y por lugar de nacimiento. Primero se identificaron predictores sobre la influencia del etiquetado de menús, y después se analizaron diferencias en la elección de alimentos/comportamientos de salud entre la población inmigrante y la nacida en EUA. Resultados. Leer las etiquetas cuando se compran víveres fue uno de los principales predictores asociados con la influencia del etiquetado de menús. Inmigrantes con más tiempo de residencia en EUA reportaron mayor capacidad de compra de "alimentos balanceados", pero también fueron más propensos a comer en restaurantes de comida rápida y menos propensos a participar en actividad física moderada/intensa. Conclusiones. Aunque el lugar de nacimiento no fue un predictor significativo del etiquetado de menús, nuestro análisis sugiere la convergencia entre la población inmigrante y la nacida en EUA en la elección de alimentos/comportamientos de salud.

Hepatitis B Screening and Vaccination Practices in Asian American Primary Care

BACKGROUND/AIMS: Screening for hepatitis B virus (HBV) is recommended in populations with anticipated prevalence > or =2%. This study surveyed HBV screening and vaccination practices of Asian American primary care providers (PCPs). METHODS: Approximately 15,000 PCPs with Asian surnames in the New York, Los Angeles, San Francisco, Houston, and Chicago areas were invited to participate in a web-based survey. Asian American PCPs with > or =25% Asian patients in their practice were eligible. RESULTS: Of 430 (2.9%) survey respondents, 217 completed the survey. Greater than 50% followed > or =200 Asian patients. Although 95% of PCPs claimed to have screened patients for HBV, 41% estimated that < or =25% of their adult Asian patients had ever been screened, and 50% did not routinely screen all Asian patients. In a multivariable analysis, the proportion of Asian patients in the practice, provider geographic origin and the number of liver cancers diagnosed in the preceding 12 months were significantly associated with a higher likelihood of screening for HBV. Over 80% of respondents reported that < or =50% of their adult Asian patients had received the HBV vaccine. CONCLUSIONS: Screening and vaccination for HBV in Asian American patients is inadequate. Measures to improve HBV knowledge and care by primary-care physicians are critically needed.

Coracoclavicular Screw Fixation and Tension Band Wiring in Treatment of Distal Clavicle Fracture

PURPOSE: The purpose of this study was to analyze the effectiveness of coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures. MATERIALS AND METHODS: From October 2006 to December 2010, 18 patients with Neer type 2 displaced distal clavicle fracture were surgically treated. Fixation was performed, using coracoclavicular screw with tension band wiring. Radiographic and clinical evaluation was performed and the University of California at Los Angeles (UCLA) shoulder rating scale was employed for the assessment of shoulder joint function. RESULTS: Osseous union was achieved approximately 9.5 weeks (8-11 weeks) in all patients. After the union, the screw and wire were removed under local anesthesia. All patients returned to the normal shoulder range of motion. Loosening of the screw was seen in two patients and breakage was seen in one patient. However, we could not observe the delayed union and complications, such as infection and refracture. All but one patient showed excellent results according to the UCLA shoulder score at one year after the operation. CONCLUSION: Coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures is a clinically useful technique with good result and less complication.

Observations of Acid Reflux and Motor Function in Distal Esophagus Using Simultaneous Measurements of Intra-esophageal pH and Pressure in 8 Directions With Novel Sensor Catheter: A Feasibility Study

BACKGROUND/AIMS: Esophagogastric junctional lesions, such as mucosal breaks with Los Angeles grade A or B reflux esophagitis, lacerations in Mallory Weiss syndrome, and short segment Barrett's esophagus, are mainly found in the right anterior wall of the distal esophagus. Asymmetrical lower esophageal sphincter pressure and resting radial asymmetrical acid reflux may be causes of this asymmetrical distribution of reflux esophagitis and short segment Barrett's esophagus. We developed a novel pH and pressure catheter to investigate the asymmetrical distributions of pH and intra-esophageal pressure in the distal esophagus. METHODS: One healthy male volunteer was enrolled in this study. Acid reflux and motor function in distal esophagus was investigated using simultaneous measurements of intra-esophageal pH and pressure in 8 directions with novel sensor catheter. RESULTS: Thirty-six acid and weak acid reflux events were observed, of which 22 were circumferential refluxes with pH drops in all channels and 14 were partial refluxes with pH drops in some channels. Increase in transient circumferential intraesophageal pressure was observed just after 72.7% of the circumferential reflux and 42.9% of the partial reflux events. CONCLUSIONS: Using a novel sensor catheter, 2 different types of acid reflux events were identified in the present study.

The Prevalence of Erosive Esophagitis Is Not Significantly Increased in a Healthy Korean Population: Could It Be Explained?: A Multi-center Prospective Study

BACKGROUND/AIMS: Researches on the potential risk factors for the development of erosive esophagitis have been conducted extensively, however, the results are conflicting. The aim of this multicenter study was to identify the prevalence rate and risk factors of erosive esophagitis and their interactions with residency status. METHODS: A total of 4,023 eligible subjects at 8 tertiary health care centers were evaluated using questionnaires, laboratory tests and endoscopy. Univariate and multivariate analyses were conducted to identify independent risk factors for erosive esophagitis. RESULTS: The prevalence rate of reflux esophagitis was 8.8%. Los Angeles grade A was common type of erosive esophagitis. Residence in a large urban areas was negatively associated with the development of erosive esophagitis (OR, 0.60; 95% CI, 0.40-0.90). The high body mass index (> or = 25 kg/m2) was more frequent in residents of small and medium-sized cities than those in big cities (38.8% and 26.9%, respectively; P or = 150 mg/dL (OR, 1.65; 95% CI, 1.08-2.07), fasting glucose level > or = 126 mg/dL (OR, 1.73; 95% CI, 1.06-2.81), and hiatal hernia (OR, 3.11; 95% CI, 1.87-5.16) were also associated with erosive esophagitis. CONCLUSIONS: The prevalence rate of erosive esophagitis and its risk factors in this study were similar to the result of 8.0% of nationwide study in 2006. Residency and obesity are more important independent risk factors than H. pylori infection status for development of erosive esophagitis in Korea. These results suggest that the prevalence rate of erosive esophagitis in Korea might not increase as in the Western countries.

The Integrity after Arthroscopically Repairing the Rotator Cuff Tendon Using the Suture Bridge Technique / 대한정형외과학회잡지

PURPOSE: We evaluated the integrity after repairing the arthroscopic rotator cuff tendon using the suture-bridge technique in patients with full thickness rotator cuff tendon tears. MATERIALS AND METHODS: Forty two (males: 14, females: 28) consecutive shoulders that were treated with this index procedure and that had magnetic resonance imaging (MRI) taken at a mean of 9 months postoperatively were enrolled to estimate the postoperative intregrity of the repair. The mean age was 57 years (range: 44-75 years) and the mean follow-up period was 14 months (range: 12-16 months). The follow up MRI was evaluated using the Sugaya classification for postoperative cuff integrity. The clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Significance was set at p values < 0.05 RESULTS: In the 42 cases with follow up MRI, the cuff integrity was graded as type I in 10 cases, type II in 28, type III in 2, type IV in 1 and type V in 1 case. Out of the 39 cases having a medium to large tear, the type I and II cuff integrity was 92.3% and two patients had type III cuff integrity postoperatively, while the rate of retear was 33.3% (1 of 3) in the cases with massive tear. The overall rate of retear was 4.8%. For the intact postoperative repair rate, the precent of cases with fatty degeneration of grade 3 or less seen on preoperative MRI was 92.7%. For 41 patients, except for 1 case of type V retear, the UCLA score and the KSS score were significantly improved (p < 0.05) from 17.2 to 31.4 and from 58.2 to 90.8 on average, respectively, which showed satisfactory clinical outcomes regardless of the type of repair integrity. CONCLUSION: The arthroscopic suture-bridge technique resulted in intact repair integrity in 90.4% of the cases and improved clinical outcomes, so we think this technique is one of the reliable procedures for treating full-thickness rotator cuff tear.

The Value of Carlsson-Dent Questionnaire in Diagnosis of Gastroesophageal Reflux Disease in Area With Low Prevalence of Gastroesophageal Reflux Disease

BACKGROUND/AIMS: Symptom-based diagnosis for gastroesophageal reflux disease (GERD) has been accepted in the population with high prevalence. Carlsson-Dent questionnaire (CDQ) is a standardized symptom-based diagnosis tool for GERD. The value of this tool in the population with low prevalence is unknown. The aim of this study was to determine CDQ performance for diagnosis of GERD in Thai population with low prevalence versus endoscopy or 24 hour pH monitoring. METHODS: Patients with dyspepsia by Rome II criteria were recruited. All patients completed a Thai version of CDQ and underwent endoscopic examination. Those without esophagitis or peptic ulcer and positive CDQ score took pH monitoring. RESULTS: One hundred patients (68 female) with mean age +/- SD of 45.6 +/- 12.4 years were recruited. Six with Los Angeles grade A esophagitis had negative CDQ score. In 44 with positive CDQ score, 3 had Los Angeles grade B esophagitis and 41 had pH monitoring done with 8 having positive test. The GERD diagnosis by CDQ was confirmed in 11 of 44 patients (25%). CDQ detected 11 out of 17 GERD detected by endoscopy and pH monitoring and the sensitivity of CDQ was 64%. CONCLUSIONS: CDQ diagnosed more GERD in Thai population with low prevalence compared with endoscopy and pH monitoring. This may be due to some patients with functional heartburn were picked up by CDQ and some patients with GERD were not detected by endoscopy and pH monitoring.

Helicobacter pylori Serology Inversely Correlated With the Risk and Severity of Reflux Esophagitis in Helicobacter pylori Endemic Area: A Matched Case-Control Study of 5,616 Health Check-Up Koreans

BACKGROUND/AIMS: The role of Helicobacter pylori in gastroesophageal reflux disease remains still controversial and the effect of the organism on severity of reflux esophagitis have been rarely issued. The aim of this study was to investigate the relationship between H. pylori infection and reflux esophagitis, and especially the severity of reflux esophagitis. METHODS: We performed a cross-sectional case-control study of 5,616 subjects undergoing both upper endoscopy and H. pylori serology during health Check-up (2,808 cases vs age- and sex-matched controls). Smoking, alcohol, body mass index and waist circum - ference were added to a multiple regression model. RESULTS: Prevalence of H. pylori infection was lower in cases with reflux esophagitis than in controls (38.4% vs 58.2%, P < 0.001) and negative associations with H. pylori infection continued across the grade of esophagitis (46.7% in Los Angeles classification M [LA-M], 34.3% in LA-A or LA-B and 22.4% in LA-C or LA-D, P < 0.001). Positive serology for H. pylori independently reduced the risk of reflux esophagitis (adjusted OR, 0.44; 95% CI, 0.39-0.49). Notably, the negative associations continued across the grade of esophagitis with adjusted ORs of 0.63 in LA-M, 0.36 in LA-A or LA-B and 0.20 in LA-C or LA-D (P < 0.001). CONCLUSIONS: In a age-sex matched Korean, H. pylori seropositivity was independently and inversely associated with the risk and severity of reflux esophagitis, suggesting the organism may have a protective role against gastroesophageal reflux disease.

In-Flight Transmission of Novel Influenza A (H1N1) / 한국역학회지

The Korea Centers for Disease Control and Prevention confirmed two patients, who had taken the same plane from Los Angeles to Seoul, with novel influenza A (H1N1). Through contact tracing, we concluded that the second patient was infected during the flight.

Arthroscopic Repair of Combined Rotator Cuff Tears Involving the Subscapularis Tendon / 대한정형외과학회잡지

PURPOSE: Subscapularis tendon tears associated with supraspinatus tendon tears are often found during rotator cuff repair. However, there have been only a few reports about both subscapularis and rotator cuff repair. The authors conducted arthroscopic repair for cuff tear associated with subscapularis tendon tear and assessed its outcomes. MATERIALS AND METHODS: We evaluated 320 cases of arthroscopic repair following rotator cuff tear between June 2006 and January 2009 at Gil Medical Center. Out of 66 cases (21%) associated with subscapularis tear, forty cases of bone to tendon repair using suture anchor were selected except for 26 cases of tendon to tendon repair. Clinical outcomes of 25 cases followed up for over a year were finally assessed. Clinical outcomes were evaluated using the following measures: range of shoulder motion, muscle strength, belly press test, Visual Analogue Scale (VAS) on pain, and University of California Los Angeles (UCLA) score. RESULTS: The average VAS pain scale improved from 5.3 preoperatively to 1.4 postoperatively. Internal rotation strength increased from its preoperative level, 4.1 to 4.2 in postoperative 6 months and to 4.6 at last follow-up. Range of internal rotation increased from the second lumbar level at postoperative 6 months to the 11th thoracic level at last follow-up. UCLA score had significantly improved from 17.4 to 30.8 (p<0.05). CONCLUSION: It is recommended that concurrent repair of the subscapularis tendon during rotator cuff repair for a satisfactory treatment result.

Halimeter ppb Levels as the Predictor of Erosive Gastroesophageal Reflux Disease

BACKGROUND/AIMS: In a previous issue published in Gut and Liver, we found that erosive changes in the esophagogastroduodenal mucosa were strongly correlated with increased levels of volatile sulfur-containing compounds (VSC), suggesting that halitosis could be a symptom reflecting the erosive status of the upper gut mucosa. Together with other studies showing a possible association between halitosis and gastroesophageal reflux disease (GERD), under the premise that halitosis could be one of extraesophageal manifestations of erosive GERD (ERD), we investigated the significance of Halimeter ppb levels on ERD compared to non-erosive gastroesophageal reflux disease (NERD). METHODS: Subjects were assigned to the NERD group if there was no evidence of esophageal erosive changes on endoscopy, despite reflux symptoms, and to the ERD group if they had GERD A, B, C, or D (according to the Los Angeles classification). The VSC levels were measured in all patients with either a Halimeter (before endoscopy) or by gas chromatography of the gastric juices aspirated during endoscopy. RESULTS: The VSC level differed significantly between the NERD and ERD groups (p24 kg/m2 was significantly associated with ERD, there was no correlation with Halimeter ppb levels. Minimal-change lesions exhibited the highest VSC levels, signifying that minimal change lesions can be classified as ERD based on our finding that halimeter ppb levels were descrimitive of erosive change. CONCLUSIONS: Erosive changes in the esophageal mucosa were strongly associated with VSC levels, supporting the hypothesis that halitosis can be a potential biomarker for the discrimination between ERD and NERD, reflecting the presence of erosive change in the lower esophagogastric junction.

Comparison of Health Locus of Control, Depression, Wellbeing, and Health Promoting Lifestyle Profile II in Middle Aged Korean and Korean-American Women / 여성건강간호학회지

PURPOSE: The purpose of this study was to identify differences in Health Locus of Control (HLOC), depression, wellbeing, and Health Promoting Lifestyle Profile II (HPLP) between middle aged Korean and Korean-American women. METHODS: Data from 80 Korean-American women living in Los Angeles, USA and 82 Korean women living in W-city, Korea, were collected using a self administered questionnaire including items on HLOC, HPLP, a Wellbeing Index and Major Depression Inventory. RESULTS: There were statistically significant differences between the middle aged Koreans and Korean-Americans on mean age, education, religion, and current health insurance. Significant differences were found on HLOC (F=2.504, p=.033) and Wellbeing (F=2.451, p=.036). The results also showed significant differences on HPLP (total HPLP, F=4.655, p=.001; physical activity, F=2.967, p=.014; nutrition, F=4.250, p=.001; spiritual growth, F=4.398, p=.001; interpersonal relations, F=2.648, p=.025; and stress management, F=5.201, p<.001) using ANCOVA. However, there were no significant differences on depression, or health responsibility in HPLP between the groups. CONCLUSION: Understanding middle aged women's health adjustments based on their culture will enhance the ability of health professionals to provide culturally congruent care and enable middle aged women to develop healthy lifestyles.

Recent Concept in Interpreting High-Resolution Manometry

Esophageal manometry is considered the gold standard for assessing esophageal motor function. Although conventional manometry has been widely used to evaluate esophageal motor function, this is not fully satisfactory for explaining esophageal symptoms. High-resolution manometry (HRM) is designed to overcome the limitations of conventional manometric systems with advanced technologies. A solid-state HRM assembly with 36 solid-state sensors spaced at 1 cm intervals (Sierra Scientific Instruments Inc., Los Angeles, CA, USA) has been widely used around the world. Calibration and post-study thermal correction should be performed at each test. The HRM assembly was passed transnasally and positioned to record from the hypopharynx to the stomach. After a 5 minutes resting period to assess basal sphincter pressure, 5 mL water swallows are obtained in a supine posture. The interpretation of HRM data is still being refined. Recently, the HRM Classification Working Group revised the Chicago classification based on a systematic analysis of motility patterns in 75 control subjects and 400 consecutive patients. The below will show you a summary of the new Chicago classification of distal esophageal motility disorders to provide a practical way of interpreting HRM.

Suicide notes from Mexico and the United States: a thematic analysis / Notas suicidas de México y Estados Unidos: un análisis temático

OBJECTIVE: This study sought to investigate suicide notes drawn from Mexico and the United States (US) as these countries share geographical proximity, but markedly different cultures and suicide rates. MATERIAL AND METHODS: A theoretical conceptual analysis of 102 suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars,1,2 across countries. RESULTS: The inter-judge reliability was adequate (.86 coefficient of concordance). CONCLUSIONS: The results suggested that there are more psychological commonalities than differences. Yet, as this study marks the first one using suicide notes, between Mexico and the USA, much greater study is warranted.

OBJETIVO: Este estudio tuvo por objetivo la comparación de notas suicidas (póstumas) de México y de Estados Unidos, países que aunque vecinos geográficos, presentan marcadas diferencias culturales y porcentajes de suicidio. MATERIAL Y MÉTODOS: Se realizó un análisis conceptual de 102 notas (51 mexicanas, 51 estadunidenses), pareadas por edad y sexo. Se utilizó el Modelo temático de suicidio desarrollado por Leenaars1,2 y que ha sido la base de varios estudios en diversos países. RESULTADOS: La técnica de Análisis de contenido obtuvo un adecuado nivel de concordancia (86%) con el Método de interjueces. CONCLUSIONES: Los resultados informan que existen más semejanzas que diferencias psicológicas entre ambas muestras. El presente es el primer estudio que utiliza notas suicidas entre ambos países.