ABSTRACT
BACKGROUND/PURPOSE: Congenital pulmonary airway malformations (CPAMs) are rare congenital lung lesions often diagnosed by prenatal ultrasound. High-risk cases can result in hydrops and prenatal or postnatal demise. Antenatal betamethasone has resulted in improved survival but it is unclear how to manage patients who do not respond to a single course. METHODS: We present a bi-institutional retrospective review of patients treated with multiple courses of prenatal steroids for high-risk CPAMs between 2007 and 2013. RESULTS: Nine patients met inclusion criteria. All but one either had an increased CPAM volume ratio (CVR) or number of fluid-containing compartments involved after a single course of antenatal betamethasone, prompting additional courses. Four patients stabilized, three improved and two progressed after the second course. The two cases with disease progression underwent an in utero resection. There were one in utero fetal demise and two deaths within the delivery room. Both fetuses that underwent a fetal resection died. All but one mother who delivered a viable fetus had complications of pregnancy. CONCLUSIONS: Multiple courses of antenatal betamethasone for high-risk fetal CPAMs often result in favorable short-term outcomes without the need for open fetal resection. Pregnancy complications are common and women within this cohort should be monitored closely.
Subject(s)
Betamethasone/administration & dosage , Cystic Adenomatoid Malformation of Lung, Congenital/drug therapy , Fetal Diseases/drug therapy , Adult , Dose-Response Relationship, Drug , Female , Glucocorticoids/administration & dosage , Humans , Infant, Newborn , Injections, Intramuscular , Male , Pregnancy , Pregnancy Outcome , Respiratory System Abnormalities/complications , Retrospective StudiesABSTRACT
Societal violence is a public health concern that confronts different countries. In this paper, the author examines the situation of community violence in Jamaica and discusses steps which could be taken by the health community to curb the pervasive and growing problem of community violence.
Subject(s)
Public Health , Residence Characteristics , Violence , Health Occupations , Humans , Jamaica/epidemiologyABSTRACT
Societal violence is a public health concern that confronts different countries. In this paper, the author examines the situation of community violence in Jamaica and discusses steps which could be taken by the health community to curb the pervasive and growing problem of community violence.
La violencia social es una preocupación de la salud pública, a la que se enfrentan diferentes países. En este trabajo, el autor examina la situación de la violencia comunitaria en Jamaica, y discute los pasos que la comunidad de la salud podría tomar para frenar el problema acuciante y creciente de la violencia comunitaria.
Subject(s)
Humans , Demography , Public Health , Violence , Jamaica/epidemiology , Health OccupationsABSTRACT
STUDY OBJECTIVES: Description of the development and results of a program in lung volume reduction surgery (LVRS) at a community hospital. DESIGN: Prospective data collection. SETTING: A 320-bed community hospital. PATIENTS: Fifty-five patients consecutively discharged from the hospital following LVRS. The mean preoperative FEV1 averaged 28% (+/-8%) of predicted values, while the preoperative PaCO2 averaged 49 mm Hg (+/-11.5 mm Hg). Forty-eight patients completed a preoperative conditioning regimen and underwent the procedure on an elective basis. Seven patients underwent the procedure during a hospital admission for a COPD exacerbation. Eight patients required mechanical ventilation preoperatively, including three who had required long-term mechanical ventilatory support. RESULTS: Three patients (5%) died in the hospital following surgery. One patient developed chronic ventilator dependence. All three of the patients who required long-term mechanical ventilation preoperatively were weaned from the ventilator and returned home. Follow-up pulmonary function testing is available for 42 patients 3 months after surgery, and for 20 patients 6 months after the operation. At 3 months, the mean FEV1 improved 0.19 L (p=0.0002), the mean improvement for FVC was 0.37 L (p=0.0001), and the mean drop in residual volume was 0.97 L (p=0.0001). Similar changes are seen at 6 months. Highly significant improvements were also seen in quality of life measurements and exercise performance. The benefits of surgical treatment of emphysema seemed similar in both elective and urgent groups. CONCLUSIONS: LVRS can be done safely and effectively at a community hospital, with significant improvement in pulmonary function and quality of life.
Subject(s)
Hospitals, Community , Patient Care Team , Pneumonectomy/statistics & numerical data , Program Development , Adult , Aged , Aged, 80 and over , Elective Surgical Procedures/statistics & numerical data , Emergencies , Female , Follow-Up Studies , Hospital Bed Capacity, 300 to 499 , Hospitals, Community/statistics & numerical data , Humans , Male , Massachusetts , Middle Aged , Patient Selection , Pneumonectomy/methods , Program Development/statistics & numerical data , Prospective Studies , Quality of Life , Treatment OutcomeSubject(s)
Humans , Adolescent , Fruit/poisoning , Hypoglycemia/epidemiology , Foodborne Diseases/epidemiology , Syndrome , JamaicaABSTRACT
This article highlights promotional strategies that are currently in use in occupational health which have yielded positive results in terms of cost-effectiveness and the prevention of occupational disease. Suggestions are offered on the possible extrapolation of these strategies to disease prevention programmes in medical practice in the Caribbean Region.
Subject(s)
Health Promotion , Occupational Health , Preventive Medicine , Health Promotion/methods , Humans , Occupational Diseases/economics , Occupational Diseases/prevention & control , West IndiesABSTRACT
This article highlights promotional strategies that are currently in use in occupational health which have yielded positive results in terms of cost-effectiveness and the prevention of occuptional disease. Suggestions are offered on the possible extrapolation of these strategies to disease prevention programmes in medical practice in the Caribbean Region. (AU)
Subject(s)
Humans , Health Promotion/methods , Health Education/methods , Occupational Health , Health Status Indicators , Quality of Life , West IndiesABSTRACT
This article highlights promotional strategies that are currently in use in occupational health which have yielded positive results in terms of cost-effectiveness and the prevention of occuptional disease. Suggestions are offered on the possible extrapolation of these strategies to disease prevention programmes in medical practice in the Caribbean Region.
Subject(s)
Humans , Health Education/methods , Occupational Health , Health Promotion/methods , Quality of Life , West Indies , Health Status IndicatorsABSTRACT
This article highlights an outbreak of food poisoning, the result of ingestion of Ciguatoxin-infected fish in a community. The case presentations of the patients involved are used to illustrate the clinical aspects of Ciguatoxin poisoning. The public health aspects of this incident and their relevance to disease surveillance are then discussed. Information of significance to general medical practice in relation to this particular type of fish poisoning, the effect of which could prove fatal in some cases, is also discussed.
Subject(s)
Ciguatera Poisoning , Disease Outbreaks/prevention & control , Fishes, Poisonous , Foodborne Diseases/etiology , Adolescent , Adult , Aged , Animals , Child , Child, Preschool , Female , Foodborne Diseases/epidemiology , Foodborne Diseases/therapy , Humans , Jamaica/epidemiology , Male , Middle AgedABSTRACT
This article highlights an outbreak of food poisoning, the result of ingestion of Ciguatoxin-infected fish in a community. The case presentations of the patients involved are used to illustrate the clinical aspects of Ciguatoxin poisoning. The public health aspects of this incident and their relevance to disease surveillance are then discussed. Information of significance to general medical practice in relation to this particular type of fish poisoning, the effect of which could prove fatal in some cases, is also discussed (AU)
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Male , Female , Ciguatoxins/poisoning , Foodborne Diseases/etiology , Fishes, Poisonous , Disease Outbreaks/prevention & control , Jamaica , Foodborne Diseases/epidemiologyABSTRACT
This article highlights an outbreak of food poisoning, the result of ingestion of Ciguatoxin-infected fish in a community. The case presentations of the patients involved are used to illustrate the clinical aspects of Ciguatoxin poisoning. The public health aspects of this incident and their relevance to disease surveillance are then discussed. Information of significance to general medical practice in relation to this particular type of fish poisoning, the effect of which could prove fatal in some cases, is also discussed
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Male , Female , Fishes, Poisonous , Disease Outbreaks/prevention & control , Ciguatoxins/poisoning , Foodborne Diseases/etiology , Foodborne Diseases/epidemiology , JamaicaABSTRACT
The importance of occupational health practice principles in the delivery of health care to the working population is stressed by the authors' management of an incident of occupational pesticide poisoning. The clinical management of the patients involved, as well as the occupational and environmental health management of that incident, is discussed. An illustrative case report is used to describe an occurrence of carbofuran pesticide poisoning in three female farm workers in Jamaica. This report highlights the implications and significance of this incident in terms of the sensitivity of the medical profession to similar occupational health problems.
Subject(s)
Agricultural Workers' Diseases/chemically induced , Carbofuran/adverse effects , Insecticides/adverse effects , Adult , Aged , Carbofuran/toxicity , Environmental Exposure , Female , Humans , Middle Aged , Protective ClothingABSTRACT
The importance of occupational health practice principles in the delivery of health care to the working population is stressed by the authors' management of an incident of occupational pesticide poisoning. The clinical management of the patients involved, as well as the occupational and environmental health management of that incident, is discussed. An illustrative case report is used to describe an occurrence of carbofuran pesticide poisoning in three female farm workers in Jamaica. This report highlights the implications and significance of this incidence in terms of the sensitivity of the medical profession to similar occupational health problems (AU)
Subject(s)
Humans , Adult , Female , Insecticides/poisoning , Occupational Diseases , JamaicaABSTRACT
The importance of occupational health practice principles in the delivery of health care to the working population is stressed by the authors' management of the an incident of occupational pesticide poisoning. The clinical management of the patients involved, as well as the occupational and environmental health management of that incident, is discussed. An illustrative case report is used to describe an occurrence of carbofuran pesticide poisoning in three female farm workers in Jamaica. This report highlights the implications and significance of this incident in terms of sensitivity of the medical profession to similar occupational health problems
