Financial and economic costs of healthcare-associated infections in Africa.

BACKGROUND: Healthcare-associated infections (HAIs) remain a global health challenge, and have elevated rates in Sub-Saharan Africa. HAIs impact patients and their families by causing illness, prolonged hospital stay, potential disability, excess costs and, sometimes, death. The costs of HAIs are increasing due to spreading antimicrobial resistance. A major risk factor for HAIs is lack of water, sanitation and hygiene (WASH); environmental cleaning and healthcare waste management. In Sub-Saharan Africa, these services are lacking in at least 50% of healthcare facilities. AIM: To estimate the costs associated with HAIs at national level in 14 countries in Sub-Saharan Africa. METHODS: Economic methodologies were employed to estimate the medical costs, productivity losses and value of premature death from HAIs, drawing on national statistics and published studies to populate the economic model. RESULTS: In 2022, the number of HAIs was estimated at 4.8 million, resulting in 500,000 deaths. Health-related economic losses amounted to US$13 billion per year, equivalent to 1.14% of combined gross domestic product and US$15.7 per capita. Healthcare costs were US$500 per HAI, and represented 5.6% of total health expenditure. The costs of providing basic WASH were US$0.91 per capita, which, if they reduced HAIs by 50%, would result in benefit-cost ratios of 1.6 (financial healthcare savings alone) and 8.6 (all economic benefits). CONCLUSION: HAIs have a major health and economic burden on African societies, and a significant proportion can be prevented. It is critical that health policy makers and practitioners dedicate policy space, resources and training to address HAIs.

Examining temporal trends in psychological distress and the co-occurrence of common substance use in a population-based sample of grade 7-12 students from 2013 to 2019.

PURPOSE: Characterizing trends and correlates of adolescent psychological distress is important due to observed global increases over the last 20 years. Substance use is a commonly discussed correlate, though we lack an understanding about how co-occurrence of these concerns has been changing over time. METHODS: Data came from repeated, representative, cross-sectional surveys of grade 7-12 students across Ontario, Canada conducted biennially from 2013 to 2019. Poisson regression with robust standard errors was used to examine changes in the joint association between psychological distress (operationalized as Kessler-6 [K6] scores ≥ 13) and substance use over time. Weighted prevalence ratios (PR) and their 99% confidence intervals were estimated, where p < 0.01 denotes statistical significance. RESULTS: The prevalence of psychological distress doubled between 2013 and 2019, with adjusted increases of about 1.2 times each survey year. This biennial increase did not differ based on sex, perceived social standing, school level, or any substance use. Students using substances consistently reported a higher prevalence of psychological distress (between 1.2 times and 2.7 times higher). There were similarly no differential temporal trends based on substance use for very high distress (K6 ≥ 19) or K6 items explored individually. CONCLUSION: Psychological distress steeply increased among adolescents and substance use remains important to assess and address alongside distress. However, the magnitude of temporal increases appears to be similar for adolescents reporting and not reporting substance use.

Can Adipose Tissue Influence the Evaluation of Thermographic Images in Adolescents?

Infrared thermography (IRT) is a technology easy to use for clinical purposes as a pre-diagnostic tool for many health conditions. However, the analysis process of a thermographic image needs to be meticulous to make an appropriate decision. The adipose tissue is considered a potential influence factor in the skin temperature (Tsk) values obtained by IRT. This study aimed to verify the influence of body fat percentage (%BF) on Tsk measured by IRT in male adolescents. A total of 100 adolescents (16.79 ± 0.97 years old and body mass index of 18.41 ± 2.32 kg/m²) was divided into two groups through the results of a dual-energy X-ray absorptiometry analysis: obese (n = 50, %BF 30.21 ± 3.79) and non-obese (n = 50, %BF 11.33 ± 3.08). Thermograms were obtained by a FLIR T420 infrared camera and analyzed by ThermoHuman® software version 2.12, subdividing the body into seven regions of interest (ROI). The results showed that obese adolescents presented lower mean Tsk values than the non-obese for all ROIs (p < 0.05), with emphasis on the global Tsk (0.91 °C) and anterior (1.28 °C) and posterior trunk (1.18 °C), with "very large" effect size values. A negative correlation was observed in all the ROI (p < 0.01), mainly in the anterior (r = -0.71, p < 0.001) and posterior trunk (r = -0.65, p < 0.001). Tables of thermal normality were proposed for different ROIs according to the classification of obesity. In conclusion, the %BF affects the registered Tsk values in male Brazilian adolescents assessed by IRT.

Consumption of energy drinks on cardiovascular and metabolic response and performance. Is there an effect? / Consumo de bebidas energéticas sobre la respuesta cardiovascular, metabólica y rendimiento. ¿Hay efecto?

Over the years, the search for nutritional strategies that promote improved sports performance has increased. Among the available options, energy drinks appear as potential nutritional resources for this purpose, because they offer, in addition to caffeine, substances that act synergistically to improve performance, such as taurine, carbohydrates, amino acids, vitamins and minerals, promoting improved performance for both amateur and professional athletes. The aim of the study was to verify the effects of ingesting energy drinks with (ED1) and without carbohydrates (ED0) containing 2 mg·kg-1 of caffeine, and a decaffeinated placebo (PL) on cardiovascular, metabolic and performance parameters during cycling. Twelve male cyclists (age = 24.4 ± 6.6 years old) volunteered to participate in this study. The protocol consisted of three experimental sessions of 60 min of continuous cycling (65-75% of VO2maxE) followed by time-trial 6 km. The subjects ingested ED1, ED0 or a placebo drink (PL) 40 min before beginning the exercise. The heart rate (HR), blood pressure (BP), plasma glucose and lactate concentrations, and the time taken to complete the 6 km time-trial were evaluated. The time taken to complete the time-trial was significantly higher (p < 0.05) in the PL group than in the groups ED1 and ED0. This time significantly decreased after the ED1 consumption relative to that for the ED0 consumption. Heart rate, systolic and diastolic arterial pressure and in the plasma glucose and lactate concentrations were similar in all the considered groups. These results demonstrate that ED1 consumption appears to be more effective at maximizing performance during the last 6 km.(AU)

Con el paso de los años, se ha incrementado la búsqueda de estrategias nutricionales que promuevan un mejor rendimiento deportivo. Entre las opciones disponibles, las bebidas energéticas aparecen como potenciales recursos nutricionales para este fin, pues ofrecen, además de la cafeína, sustancias que actúan sinérgicamente para mejorar el rendimiento, como taurina, carbohidratos, aminoácidos, vitaminas y minerales, promoviendo un mejor rendimiento para atletas tanto aficionados como profesionales. El objetivo del estudio fue verificar los efectos de la ingestión de bebidas energéticas con (ED1) y sin carbohidratos (ED0) que contienen 2 mg · kg-1 de cafeína y un placebo descafeinado (PL) sobre los parámetros cardiovasculares, metabólicos y de rendimiento durante el ciclismo. Doce ciclistas varones (edad = 24,4 ± 6,6 años) participaron voluntariamente en este estudio. El protocolo consistió en tres sesiones experimentales de 60 min de ciclismo continuo (65-75% del VO2max) seguidas de una prueba contrarreloj de 6 km. Los sujetos ingirieron ED1, ED0 o una bebida placebo (PL) 40 minutos antes de comenzar el ejercicio. Se registró la frecuencia cardíaca (FC), la presión arterial (PA), las concentraciones plasmáticas de glucosa y lactato y el tiempo necesario para completar la prueba contrarreloj de 6 km. El tiempo necesario para completar la contrarreloj en el grupo PL fue significativamente mayor (p <0,05) que en los grupos ED1 y ED0. Este tiempo disminuyó significativamente después del consumo de ED1 en relación con el consumo de ED0. La frecuencia cardíaca, la presión arterial sistólica y diastólica y las concentraciones plasmáticas de glucosa y lactato fueron similares en todos los grupos. Estos resultados demuestran que el consumo de ED1 parece ser más eficaz para maximizar el rendimiento durante los últimos 6 km.(AU)

Experimental Ductility of Compression-Controlled Flexural Members Using CFRP Grid to Confine Concrete.

Concrete members are typically designed so that flexural failure initiates with steel yielding and ends with concrete crushing in compression in order to take advantage of the yielding property of steel that allows for large deformations prior to any fracture of the material. On the other hand, if a large percentage of steel or linear elastic non-yielding reinforcement (i.e., FRP composite) is used, the member flexural failure typically initiates and ends with concrete crushing in compression. These members are known as compression-controlled members and typically exhibit brittle behavior. This study proposes a new approach in improving the flexural behavior of over-reinforced members through concrete confinement using carbon fiber reinforced polymer (CFRP) grid tubes in the compression zone. The concept was experimentally tested using rectangular beams. Beam 1 (control beam) had no grid reinforcement and beam 2 (tube beam) had two 152 mm grid tubes embedded in its compression zone. Experimental results indicate improvement in the ductility of the tube beam compared to the control beam of approximately 20-30% depending on the criteria used. Considering the low amount and mechanical properties of the CFRP grid, the improvement is significant, which shows that the proposed approach is valid and improves the ductility of compression-controlled members.

Effects of conventional and sugar-free energy drinks intake in runners: a double-blind, randomized, placebo-controlled crossover clinical trial.

BACKGROUND: This study evaluated the effects of two types of energy drinks (ED) intake in trained runners. METHODS: A double-blind randomized placebo-controlled clinical trial was conducted over 6 weeks. Participants and beverages were allocated by randomization. Twelve men 23±2.6 years, 177±3.4 cm, 74.4±5.5 kg, VO2max=59.8±5.5 mL·(kg.min)-1] ingested either a conventional energy drink containing carbohydrates and 3 mg·kg-1 of caffeine, (ED1), a sugar-free energy drink 3 mg·kg-1 of caffeine (ED2), or a carbohydrate-containing, decaffeinated placebo (PL) 40-minutes before an exercise protocol. Sprint time, rate of perceived exertion (RPE), respiratory exchange ratio (RER), blood pressure (BP), heart rate and plasmatic glucose were evaluated during the experimental protocol. RESULTS: Performance improved after consuming both ED (P<0.004 ED1 and P=0.001 ED2) with lower RPE (P<0.05 for ED1 and P<0.05 for ED2) compared to PL. Consumption of ED2 decreased RER values at 0-5 minutes and 40-45 minutes (P<0.001), and ED1 increased systolic BP (P<0.05) during exercise compared to PL. There were no differences in the evaluated parameters between EDs (P>0.05). CONCLUSIONS: Consumption of conventional or sugar free ED represents a valid ergogenic strategy to improve acute performance with reduction of RPE. However, intake of a conventional ED warrants caution, mainly because the effects on systolic BP.

Adherence to 24-hour movement guidelines and academic performance in adolescents.

OBJECTIVE: The aim of the study was to examine the association between meeting combinations of the Canadian 24-h movement guidelines and academic performance in adolescents. STUDY DESIGN: This cross-sectional study used the 2017 Ontario Student Drug Use and Health Survey, a survey representative of Ontario students in grades 7-12 attending publicly funded schools. A total of 10,160 students were included in the analysis. METHODS: Moderate to vigorous physical activity (MVPA), screen time, sleep duration, and academic performance were self-reported. A multiple linear regression model was used to examine differences in academic performance between adolescents meeting and those not meeting the combinations of movement guidelines (≥60 min/day of MVPA; ≤2 h/day of screen time; 9-11 h/night of sleep for ages 11-13 years, 8-10 h/night for ages 14-17 years, and 7-9 h/night for ages 18 years or older). Covariates included age, sex, ethnicity, subjective socio-economic status, body mass index z-score, and substance use. RESULTS: We found that 5.1% of students met all three movement guidelines, whereas 39.0% did not meet any. Middle school students who met all three guidelines or either the screen time or sleep guideline displayed better academic performance than those who met none of the guidelines. High school students who met the screen time and sleep guidelines displayed better academic performance than those who did not meet any guidelines. CONCLUSIONS: Adhering to screen time and sleep duration recommendations is associated with better academic performance among adolescents.

Use of social networking sites, electronic cigarettes, and waterpipes among adolescents.

OBJECTIVES: Electronic cigarettes (e-cigarettes) and waterpipes are gaining in popularity among adolescents in tandem with the increasing popularity of social networking sites (SNSs). The objective of this study was to examine the associations between the use of SNSs and e-cigarette and waterpipe use among adolescents, and to test whether these associations are independent of tobacco cigarette smoking. STUDY DESIGN: A province-wide school-based cross-sectional study. METHODS: Data were derived from the 2013 Ontario Student Drug Use and Health Survey. Our analyses included representative data from 2841 high school students across Ontario, Canada, who completed the questionnaire that included measures of lifetime use of e-cigarette and past-year use of waterpipe. RESULTS: Nearly 14.6% of students reported having smoked an e-cigarette in their lifetime and 12.2% reported having smoked a waterpipe in the past year. After adjusting for various covariates, daily use of SNSs of at least 1 h/day was associated with greater odds of e-cigarette use (odds ratios ranged from 3.31 for SNS use of 1 h/day to 3.43 for ≥3 h/day), while daily use of SNSs of at least 2 h was associated with waterpipe use (odds ratios of 3.28 for SNS use of 2 h/day and 2.83 for use of ≥3 h/day). The observed associations remained significant after further adjusting for tobacco cigarette smoking. CONCLUSIONS: The use of SNSs was positively associated with e-cigarette and waterpipe use, independent of tobacco cigarette smoking. These findings highlight the need for including SNSs in ongoing prevention and intervention efforts.

External iliac vein aneurysm: a case report and review of the literature.

Iliac vein aneurysms are extremely rare, even amongst vein aneurysms. We discuss the case of a 26-year-old man with an external iliac vein aneurysm, likely secondary to iatrogenic vascular trauma in the neonatal period. It is the first reported case of an iliac vein aneurysm presenting with lower urinary tract symptoms. Attempts at endovenous management were unsuccessful and therefore the patient underwent open aneurysmectomy. A PubMed literature search revealed a total of nine case reports of iliac vein aneurysms published in English since 2011. We discuss the aetiology, presentation, investigation and management of iliac vein aneurysms and compare to our own case.

Perceptions and attitudes about body weight and adherence to the physical activity recommendation among adolescents: the moderating role of body mass index.

OBJECTIVE: We examined the associations between perceptions and attitudes about body weight and adherence to the physical activity recommendation (PAR) for adolescents to achieve ≥60 min/day of moderate-to-vigorous physical activity and tested whether body mass index (BMI) was a moderator of these relationships. STUDY DESIGN: Cross-sectional survey. METHODS: Self-reported data from Canadian adolescents (n = 4299) who participated in the 2013 Ontario Student Drug Use and Health Survey were analysed. RESULTS: Dissatisfaction with body weight was associated with lower odds of adherence to the PAR (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.55-0.99). More specifically, those who perceived themselves as overweight/obese had lower odds of adherence to the PAR (OR: 0.59; 95% CI: 0.42-0.81) compared with those who think they were about the right weight. Those who were trying to gain weight were more likely to adhere to the PAR (OR: 1.92; 95% CI: 1.29-2.86) compared to those who were doing nothing about their body weight. BMI was a significant moderator of the association between dissatisfaction with body weight and adherence to the PAR. At low BMI, there were no differences in the adherence to the PAR between adolescents who were dissatisfied with their body weight or not. At high BMI, adolescents who were dissatisfied with their body weight were less likely to adhere to the PAR than those who were not dissatisfied with their weight. Results were not different between males and females. CONCLUSIONS: Results suggest that adolescents who are dissatisfied with their body weight have lower adherence to the PAR, particularly those who are overweight or obese.

Use of social networking sites and perception and intentions regarding body weight among adolescents.

OBJECTIVE: Social networking sites (SNSs) not only offer users an opportunity to link with others but also allow individuals to compare themselves with other users. However, the link between the use of SNSs and the dissatisfaction with body weight is largely unknown. We investigated the associations between the use of SNSs and the perception of body weight and related behaviours among adolescent men and women. METHODS: The study sample consisted of 4,468 (48.5% women) 11-19-year-old Canadian students in grades 7 to 12 who participated in the 2013 Ontario Student Drug Use and Health Survey. RESULTS: Overall, 54.6% of students reported using SNSs for 2 h or less per day, 28.0% reported using them for more than 2 h d-1 and 17.4% reported infrequent or no use of SNSs (reference category). After adjustment for covariates, results showed that adolescent women who use SNSs for more than 2 h d-1 had greater odds of dissatisfaction with body weight (odds ratio = 2.02; 95% confidence interval [CI]: 1.30-3.16). More specifically, they were more likely to perceive themselves as overweight (relative risk ratio [RRR] = 2.20; 95% CI: 1.34-3.60) compared with those who reported infrequent or no use of SNSs. Conversely, men who use SNSs for 2 h or less per day presented a lower risk for perceiving themselves as overweight (RRR = 0.68; 95% CI: 0.47-0.98) but not those who use SNSs for more than 2 h d-1. Women who use SNSs for more than 2 h d-1 reported a greater likelihood of trying to lose weight (RRR = 2.52; 95% CI: 1.62-3.90). CONCLUSIONS: Our results showed that heavy use of SNSs is associated with dissatisfaction with body weight in adolescent women.

Altas taxas de sedentarismo e fatores de risco cardiovascular em pacientes com hipertensão arterial resistente / High rates of physical inactivity and cardiovascular risk factors in patients with resistant hypertension

A hipertensão arterial sistêmica é uma doença multifatorial, de alta prevalência na população brasileira e mundial e constitui o principal fator de risco tratável para as doenças cardiovasculares. Objetivos: Verificar a prevalência, de acordo com o sexo, dos comportamentos de risco e das comorbidades associadas à hipertensão nos pacientes atendidos no Centro Hiperdia de Viçosa, MG Métodos: Estudo transversal que avaliou 172 prontuários de hipertensos maiores de 18 anos, não diabéticos, encaminhados ao Centro Hiperdia de Viçosa. Entre os dados avaliados a partir de análise de prontuários estão os fatores e comportamentos de risco cardiovascular como sobrepeso/obesidade,dislipidemia, tabagismo, etilismo e sedentarismo, bem como condições clínicas ou comorbidades associadas à HAS. Para análise dos dados foram empregados os testes de Kolmogorov-Smirnov, o teste de Mann-Whitney e o teste de correlação de Pearson. O nível de significância adotado foi de 5%. Resultados: Observou-se uma prevalência maior de homens entre os hipertensos analisados e as taxas de etilismo e tabagismo foram significativamente maiores neste grupo. As mulheres apresentaram uma taxa maior de obesidade. O sedentarismo e a dislipidemia estiveram presentes em 77% e 44% dos pacientes, respectivamente, sem diferença entre os sexos. Hipertensão arterial resistente foi encontrada em 71% dos pacientes. Dentre as condições clínicas relacionadas à hipertensão, houve um predomínio da hipertrofia do ventrículo esquerdo, seguida pela doença renal e pela doença cerebrovascular.Conclusões: O estudo mostrou que 71 % dos pacientes eram classificados como hipertensos resistentes e que, além desta séria condição, os mesmos ainda apresentavam uma combinação de comportamentos e fatores de risco que conferem um alto risco de complicações cardiovasculares...

Hypertension is a multifactorial disease of high prevalence in Brazil and the world’s populationand is the major treatable risk factor for cardiovascular disease.Objectives: To investigate the prevalence, according to sex, of risk behaviors and comorbidities associated with Hypertension.in the treated patients in Hiperdia Center Viçosa, MGMethods: Cross-sectional study that evaluated 172 medical records of hypertensive patients greater than 18 years, nondiabetic, referred to the center of Viçosa Hiperdia. Among the data evaluated from analysis of medical records are the factors and behaviors of cardiovascular risk as overweight / obesity,dyslipidemia, smoking, drinking and physical inactivity, as well as medical conditions or comorbidities associated with hypertension. For data analysis were used the Kolmogorov-Smirnov test, Mann-Whitney test and the Pearson correlation test. The level of significance was 5%. Results: There was a higher prevalence of men among the patients and rates of alcoholism and smoking were significantly higher in this group. Women had a higher rate of obesity. Physical inactivity and dyslipidemia were present in 77% and 44% of patients, respectively, with no difference between sexes. Resistant Hypertension was found in 71% of patients. Lower education was also very present among the hypertensive. Among the clinical conditions related to hypertension, there was a predominance of left ventricular hypertrophy, followed by kidney disease and cerebrovascular disease. Conclusions: The study showed that 71% of patients were classified as resistant Hypertension and that, beyond this serious condition, they still showed a combination of behaviors and risk factors that confer a high risk of cardiovascular complications...

Social networking sites and mental health problems in adolescents: The mediating role of cyberbullying victimization.

BACKGROUND: Previous research has suggested an association between the use of social networking sites (SNSs) and mental health problems such as psychological distress, suicidal ideation and attempts in adolescents. However, little is known about the factors that might mediate these relationships. The present study examined the link between the use of social networking sites and psychological distress, suicidal ideation and suicide attempts, and tested the mediating role of cyberbullying victimization on these associations in adolescents. METHODS: The sample consisted of a group of 11-to-20-year-old individuals (n=5126, 48% females; mean±SD age: 15.2±1.9 years) who completed the mental health portion of the Ontario Student Drug Use and Health Survey (OSDUHS) in 2013. Multiple logistic regression analyses were used to test the mediation models. RESULTS: After adjustment for age, sex, ethnicity, subjective socioeconomic status (SES), and parental education, use of SNSs was associated with psychological distress (adjusted odds ratio, 95% confidence interval=2.03, 1.22-3.37), suicidal ideation (3.44, 1.54-7.66) and attempts (5.10, 1.45-17.88). Cyberbullying victimization was found to fully mediate the relationships between the use of SNSs with psychological distress and attempts; whereas, it partially mediated the link between the use of SNSs and suicidal ideation. CONCLUSION: Findings provide supporting evidence that addressing cyberbullying victimization and the use of SNSs among adolescents may help reduce the risk of mental health problems.

The role of permissive hypotension in the management of ruptured abdominal aortic aneurysms.

The aim of this review was to explore current literature pertaining to the use of permissive hypotension in the treatment of abdominal aortic aneurysms. A literature search using Metalib, a database search engine, provided at the Royal Free and University College of London (UCL) yielded articles using the keywords "permissive hypotension" and "hypotensive resuscitation" when linked to "abdominal aortic aneurysm" and "rupture". The articles studying permissive hypotension in animals and humans in trauma, and in patients with abdominal aortic aneurysm were reviewed. The result of this search was a large volume of experimental studies of trauma in animals giving satisfactory evidence of the physiological benefit of this concept of resuscitation in trauma. There were some randomized trials in humans in trauma suggesting benefit. The safety of permissive hypotension in patients with ruptured aortic aneurysms was documented and found to be widespread, but there were no randomized trials directly comparing this practice. Evidence from a prospective randomized study on the modality of treatment of ruptured aortic aneurysms suggest that the level of blood pressure is associated with the mortality and a prospective cohort study suggests that, using the complementary concept of "delayed volume resuscitation", the total volume of preoperative fluid resuscitation independent of the blood pressure is predictive of the risk of perioperative death in ruptured aortic aneurysms. To this end, recent clinical publications are now supportive of control of both the volume of preoperative fluid given and blood pressure in this group of patients but clinical studies are few.

Editor's choice - A shaggy aorta is associated with mesenteric embolisation in patients undergoing fenestrated endografts to treat paravisceral aortic aneurysms.

OBJECTIVES: Bowel ischaemia is a life-threatening complication of endovascular aneurysm repair. This study aims to evaluate the factors associated with mesenteric ischaemia in patients undergoing fenestrated aortic endografts to treat paravisceral aneurysms. METHODS: Consecutive patients undergoing double or triple fenestrated stent graft insertion were retrospectively analysed. No patients were declined surgery based on anatomic complexity. Preoperative demographics, procedure-related variables, and anatomical factors were examined. Using 3D software, the aortic thrombus volume from the coeliac axis to the lowest renal, aortoiliac tortuosity, and aortic irregularity index (as graded by 3 independent assessors, graded 0-3 based on severity) were compared. Univariate analysis was performed to identify risk factors for the development of bowel ischaemia. RESULTS: Ninety-nine patients underwent elective aneurysm repair (64 triple fenestrations and 35 double fenestrations), 5% of which developed bowel ischaemia, and of these 80% (4/5) died. Mesenteric ischaemia was significantly associated with increased aortic irregularity (median [range], 2 [1-3] vs. 1 [0-2], p = .005, ischaemia vs. no ischaemia) and increased thrombus volume (37 ± 8 vs. 21 ± 12, p = .007) but not aortoiliac tortuosity (1.4 [1.2-1.5] vs. 1.30 [1.2-1.7], p = .3), inferior mesenteric or internal iliac artery patency. Mesenteric ischaemia was also associated with a significantly higher preoperative creatinine (mean ± SD: 183 ± 74 vs. 111 ± 43, p = .007). CONCLUSIONS: The presence of aortic irregularity and increased thrombus volume in the paravisceral segment predicts the occurrence of mesenteric and renal ischaemia in patients treated with fenestrated endografts. This is likely to be related to graft manipulation and catheterisation of visceral vessels.

Caries management by risk assessment care paths for prosthodontic patients: oral microbial control and management.

The development of an oral care path focuses on the identification of the early indicators of disease. Once the risks have been identified and diagnosed, the proper therapies can be selected and prescribed. The experienced practitioner must meld clinical experience and observation with evidence-based scientific dentistry and information on the treatment and prevention of continued disease for the prosthodontic patient after restorations have been completed. The incorporation of dental implants has not allowed for complications of caries and periodontal disease on teeth and implants. Osseoseparation is necessary for justification of continued maintenance.

Exploring child maltreatment and its relationship to alcohol and cannabis use in selected Latin American and Caribbean countries.

OBJECTIVES: Research from developed countries shows that child maltreatment increases the risk for substance use and problems. However, little evidence on this relationship is available from developing countries, and recognition of this relationship may have important implications for substance demand reduction strategies, including efforts to prevent and treat substance use and related problems. Latin America and the Caribbean is a rich and diverse region of the world with a large range of social and cultural influences. A working group constituted by the Inter-American Drug Abuse Control Commission and the Center for Addiction and Mental Health in June, 2010 identified research on this relationship as a priority area for a multinational research partnership. METHODS: This paper examines the association between self-reported child maltreatment and use in the past 12 months of alcohol and cannabis in 2294 university students in seven participating universities in six participating countries: Colombia, El Salvador, Jamaica, Nicaragua, Panama and Uruguay. The research also considers the possible impact of religiosity and minimal psychological distress as factors contributing to resiliency in these samples. RESULTS: The results showed that experience of maltreatment was associated with increased use of alcohol and cannabis. However, the effects differed depending on the type of maltreatment experienced. Higher levels of religiosity were consistently associated with lower levels of alcohol and cannabis use, but we found no evidence of an impact of minimal psychological distress on these measures. CONCLUSIONS: This preliminary study shows that the experience of maltreatment may increase the risk of alcohol and cannabis use among university students in Latin American and Caribbean countries, but that higher levels of religiosity may reduce that risk. More work to determine the nature and significance of these relationships is needed.

Early arteriovenous fistula after radiofrequency ablation of long saphenous vein.

A 75-year-old woman developed an arteriovenous fistula (AVF) between the common femoral artery and common femoral vein following radiofrequency ablation (RFA) of left long saphenous vein. Failed coil embolization of the AVF was followed by successful surgical ligation. Awareness of the aetiology of this uncommon complication of RFA and its treatment options is important with the increasing use of RFA for varicose vein treatment.

The classification of degenerative hip disease.

It is probable that both genetic and environmental factors play some part in the aetiology of most cases of degenerative hip disease. Geneticists have identified some single gene disorders of the hip, but have had difficulty in identifying the genetics of many of the common causes of degenerative hip disease. The heterogeneity of the phenotypes studied is part of the problem. A detailed classification of phenotypes is proposed. This study is based on careful documentation of 2003 consecutive total hip replacements performed by a single surgeon between 1972 and 2000. The concept that developmental problems may initiate degenerative hip disease is supported. The influences of gender, age and body mass index are outlined. Biomechanical explanations for some of the radiological appearances encountered are suggested. The body weight lever, which is larger than the abductor lever, causes the abductor power to be more important than body weight. The possibility that a deficiency in joint lubrication is a cause of degenerative hip disease is discussed. Identifying the phenotypes may help geneticists to identify genes responsible for degenerative hip disease, and eventually lead to a definitive classification.