Epidemiology of Trigger Finger: Metabolic Syndrome as a New Perspective of Associated Disease.

Objective: The aim of this study was to identify the main diseases related to trigger finger. Methods: A retrospective, observational study was performed with data obtained through a computerized record of 75 patients with trigger finger diagnosis between July 2011 and October 2015. The diagnosis of metabolic syndrome was performed following National Cholesterol Education Program Adult Treatment Panel III (2001). Results: Patients' ages ranged from 50 to 84 years, with a mean age of 63 years. The ring finger was the most affected, followed by the middle finger, index finger, and little finger. Most had a grade 2 trigger finger classified by Green; the right hand involvement was more prevalent, as was the dominant hand. The incidence in women was twice as high as in men. Arterial hypertension, diabetes mellitus, and dyslipidemia were shown to be important associated diseases, but metabolic syndrome was the main association found. Conclusions: Metabolic syndrome in the group of patients studied in this scientific article seems to be the main associated disease.

Optimum bolus wizard settings in insulin pumps in children with Type 1 diabetes.

AIM: To evaluate current insulin pump settings in an optimally regulated paediatric population using bolus wizard. METHODS: We used a retrospective study design to analyse data from 124 children on insulin pump therapy who had optimum HbA1c levels [< 59 mmol/mol (< 7.5%)] and no history of severe hypoglycaemic events. Bolus wizard settings were used to calculate the insulin to carbohydrate factors and insulin sensitivity factors. Multiple regression analysis was used to analyse the variables associated with the calculation factors. RESULTS: Insulin to carbohydrate factor varied from 276 in the youngest group to 424 in the oldest group, and increased according to age. Insulin sensitivity factor was highest in the group aged 6 to < 12 years, with a value of 125. Age, amount of carbohydrates, number of boluses per day and insulin per kg were all significantly associated with both calculation factors. Furthermore, duration of insulin pump treatment was significantly associated with insulin sensitivity factor and percentage bolus/basal was significantly associated with insulin to carbohydrate factor. Gender, diabetes duration and BMI were not associated with any of the calculation factors. CONCLUSION: Optimum insulin pump settings at pump initiation depend on both insulin requirements and use of the pump. Settings need to be individualized because the standardized calculation factors are not constant for children. There is a need to develop specific age- and insulin dose-dependent calculation factors.

Analysis of a territorial approach to the delivery of nursing home care services based on historical data.

We analyze a territorial approach to deliver nursing homecare services to a territory public health. We present the case of the CSSS assigned to Côte-des-Neiges, Métro center and Parc Extension, specifically the case of the Côte-des-Neiges site (CLSC CDN), where a territorial approach is used since 1980. We first give an historical comparison of patient visits delivered in 1998-1999 and in 2002-2003. We follow with an in-depth analysis of the home services delivered in 2002-2003 to determine whether or not the territorial approach can well support the changing needs of the population. We conclude that the territorial approach to deliver homecare nursing services does not sufficiently support fluctuations in population needs for services. Not only is it difficult to predict these fluctuations, but it is difficult to accurately quantify the true needs for services since the availability of nursing services tends to determine the services actually delivered. In sectors of the territory where resources are more scarce (based on previous population needs analyses) or demand for services is greater, the result is work overload for the nursing staff. In addition, this results in service delivery inequities across the entire territory. Therefore, a more dynamic assignment of clients to the nurses based on each nurse's work load and case load rather than based on the geographic location of clients is worth the extra administrative time in case assignment to ensure a more equitable case load attribution between nurses as well as less inequities between clients in terms of service delivery considering their needs.

Cost-effectiveness of a systematic training programme in breast self-examination.

Breast self-examination (BSE) appears to be an effective method for earlier detection of breast cancer. The provision of specialized training programmes in BSE may increase the awareness of breast cancer as well as improve the practice of BSE. This study assessed the cost-effectiveness of a BSE programme that a Danish health authority is considering implementing. A model was developed that related the cost of training (of a specified target group) to the anticipated effects of the training. These anticipated effects included increased knowledge of BSE, more routine use of BSE, fewer cases diagnosed with breast cancer where the tumour is larger than 20 mm and fewer cases where the cancer has spread to lymph nodes. The model was calibrated with data synthesized from the literature, own survey data and local expert guess. In the baseline scenario, the incremental cost per person with better knowledge of BSE was estimated to be 106 euro (2002 price level), the cost per person who begins to undertake BSE to be 180 euro, and the cost per person who correctly applies the technique to be 142 euro. The cost per avoided cancer with spreading to lymph nodes was estimated to be 15 410 euro and the cost of avoiding a cancer tumour larger than 20 mm to be 16 318 euro. Sensitivity analysis showed that these cost-effectiveness ratios varied with different assumptions for the effects of BSE training.

Delivery of pediatric after-hours care by call centers: a multicenter study of parental perceptions and compliance.

BACKGROUND: Despite the rapid growth of centralized call centers to provide after-hours triage to patients of multiple providers, little is known about the perceptions of parents regarding this type of care and their compliance with triage disposition recommendations. DESIGN/METHODS: From August through September 1999, randomized samples of after-hours calls were selected each day from computerized records at 4 pediatric call centers at 1) Children's Hospital, Denver, Colorado; 2) Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 3) Rainbow Babies and Children's Hospital, Cleveland, Ohio; and 4) All Children's Hospital, St Petersburg, Florida. All participating call centers use the same triage software. Calls were randomly selected to yield at least 250 callers with nonurgent dispositions and 100 with urgent dispositions from each site. Telephone surveys to callers were conducted by an external survey unit 3 to 7 days after the call to the call center. RESULTS: Surveys were completed for 70.5% of those sampled (N = 1561). Parents indicated they were very satisfied or satisfied with aspects of care received from 92.6% (waiting time) to 99.4% (nurse courteousness) of the time. Satisfaction did not differ by site or by recommended disposition of the index call. Most parents (65.2%) reported no preference about speaking with a physician or nonphysician for after-hours care, whereas 27.7% preferred to speak with a physician. Usually speaking with a physician during office hours (odds ratio [OR]: 1.48), feeling it was important that provider knows child's medical history (OR: 3.47), and respondent having an educational level of college graduate or higher (OR: 1.30) were significant predictors of preferring to speak with a physician. Of the 37.0% (N = 723) of parents who reported any change in their relationship with their primary provider as a result of the after-hours call center, 95.7% (N = 691) assessed the change to be positive. Reported compliance with the call center disposition recommendation was 83.3% for urgent referral, 41.0% for next day, 4.5% for visit at a later time, and 78.2% for home care. The major reason given by parents for noncompliance was reporting that they heard a different disposition (76.9% for urgent to 100% for visit at a later time). CONCLUSIONS: Parental satisfaction with pediatric call centers was uniformly high in 4 different geographic locations, and almost all parents who reported any effect on their relationship with their primary provider assessed it as positive. Compliance with recommendations for urgent evaluation or home care was relatively high but for intermediary dispositions was low. In most cases in which noncompliance occurred, parents reported hearing a different disposition. Additional study is needed to clarify whether noncompliance, especially in cases in which an urgent recommendations was made, is attributable to poor nurse communication of the recommended disposition, parental misinterpretation, or parental difference of opinion.

Agricultural pesticide use in California: pesticide prioritization, use densities, and population distributions for a childhood cancer study.

Several studies have suggested an association between childhood cancer and pesticide exposure. California leads the nation in agricultural pesticide use. A mandatory reporting system for all agricultural pesticide use in the state provides information on the active ingredient, amount used, and location. We calculated pesticide use density to quantify agricultural pesticide use in California block groups for a childhood cancer study. Pesticides with similar toxicologic properties (probable carcinogens, possible carcinogens, genotoxic compounds, and developmental or reproductive toxicants) were grouped together for this analysis. To prioritize pesticides, we weighted pesticide use by the carcinogenic and exposure potential of each compound. The top-ranking individual pesticides were propargite, methyl bromide, and trifluralin. We used a geographic information system to calculate pesticide use density in pounds per square mile of total land area for all United States census-block groups in the state. Most block groups (77%) averaged less than 1 pound per square mile of use for 1991-1994 for pesticides classified as probable human carcinogens. However, at the high end of use density (> 90th percentile), there were 493 block groups with more than 569 pounds per square mile. Approximately 170,000 children under 15 years of age were living in these block groups in 1990. The distribution of agricultural pesticide use and number of potentially exposed children suggests that pesticide use density would be of value for a study of childhood cancer.

On a common structure of intelligence in biological and technical systems.

This is a survey of the general structure of an electronic computer-implemented, operation-oriented system, designed by the authors, which uses artificial intelligence mechanisms and is intended for the control of technical objects that function both in predictable and random environments. The system is based on processing knowledge, which is stored in a hierarchically arranged Knowledge Bank, and program mechanisms for adapting to and interacting with the External and Internal Worlds. The system has distributed program mechanisms, which are 'designed' with a constant structure. It is independent of the purpose and environment of the system operation and the specific features of the controlled object. None of the program mechanisms are concentrated in any program module. They are distributed in many modules, and therefore there is no single module responsible for the execution of a particular external function. The system is structured into separate program modules by internal procedures. The conceptual organisation of the Knowledge Base presupposes that the framework is structured according to functional, semantic and tier indications, i.e. the structured description of knowledge, by the system, of the external environment and its possible behaviour in it. The possibility of multiple use of the same elements of the lower tiers of the Knowledge Base by higher-tier elements makes the proposed Knowledge Base very efficient. If the cerebrum is considered at a structural level, there appears to be an amazing similarity between the structure and the mechanisms of the above system and the structure of the cerebral cortex, as suggested previously by Edelman and Mountcastle. Each mechanism of the cerebral cortex structure has a structural analogue in the described system.(ABSTRACT TRUNCATED AT 250 WORDS)