Patient-reported rates of chronic pain and recurrence after groin hernia repair.

BACKGROUND: The effectiveness of different procedures in routine surgical practice for hernia repair with respect to chronic postoperative pain and reoperation rates is not clear. METHODS: This was prospective cohort study based on a unique combination of patient-reported outcomes and national registry data. Virtually all patients with a groin hernia repair in Sweden between September 2012 and April 2015 were sent a questionnaire 1 year after surgery. Persistent pain, defined as at least 'pain present, cannot be ignored, and interferes with concentration on everyday activities' in the past week was the primary outcome. Reoperation for recurrence recorded in the register was the secondary outcome. RESULTS: In total, 22 917 patients (response rate 75·5 per cent) who had an elective unilateral groin hernia repair were analysed. Persistent pain present 1 year after hernia repair was reported by 15·2 per cent of patients. The risk was least for endoscopic total extraperitoneal (TEP) repair (adjusted odds ratio (OR) 0·84, 95 per cent c.i. 0·74 to 0·96), compared with open anterior mesh repair. TEP repair had an increased risk of reoperation for recurrence (adjusted OR 2·14, 1·52 to 2·98), as did open preperitoneal mesh repair (adjusted OR 2·34, 1·42 to 3·71) at 2·5-year follow-up. No other methods of repair differed significantly from open anterior mesh repair. CONCLUSION: The risk of significant pain 1 year after groin hernia repair in routine surgical practice was 15·2 per cent. This figure was lower in patients who had surgery by an endoscopic technique, but at the price of a significantly higher risk of reoperation for recurrence.

Role of communities in decision-making eye care programs.

The concept of primary health care involves educating people to live their lives in ways beneficial to their health. Communities as a whole must participate in the decision-making that is involved in such education, be it promotive, preventive, curative, or rehabilitative. I refer to this participation as "participatory communication." It is based on two fundamental tenets: 1) Everyone in a community has some special knowledge to contribute to the development of the health of that community; and 2) No person is superior to another. Subsequent to sociological and anthropological studies of communities in the Southern Sudan by the Norwegian Church Aid, the Norwegian Association of the Blind and Partially-Sighted conducted village workshops based on this concept.

Training rural health staff for oral rehydration therapy in southern Sudan.

From February 1980 to August 1982 a very definite change occurred in the treatment pattern for diarrhoea among the rural health staff in Torit and Kapoeta districts in Eastern Equatoria Province in Sudan. This paper describes a training and supervision programme for promoting use of ORT in diarrhoeal diseases and at the same time discouraging the use of sulphonamides in simple diarrhoea. In the training programme emphasis is put on increasing the knowledge of the health staff both about the medical facts and about communication with their communities. ORS as treatment for diarrhoea has been well accepted by the public, who consider the sugar/salt solution as "good medicine". The use of sulphonamides for diarrhoea has decreased from 75% to 22% of the diarrhoea cases, while use of ORS has increased from 7% to 72% of the diarrhoea cases.

PIP: A training and supervision program for promoting use of oral rehydration therapy (ORT) in diarrheal diseases is described. The use of sulfonamides in simple diarrhea is discouraged. Emphasis is put on increasing the knowledge of the health staff both about the medical facts and about communication with their communities. During 1980, a severegastroenteritis epidemic struck Southern Sudan caused by cholera, during which ORT was introduced. Prepackaged oral rehydration salt (ORS) hs since supplied to the health stations. After the epidemic was controlled, a training program was launched by Norwegian Church Aid/Sudan Programme. Local health workers attended a 4-day workshop on the treatment and prevention of diarrheal diseases and were visited by medical staff for individual on-the-job training and supervision. It was considered important to stress the need for preventing diarrhea. Workshops on ORT and pure water were conducted. ORT was presented as a new and more effective treatment. Media used were: drama, cassettes, flipcharts, handbills, and demonstrations. To evaluate the program, a retrospective check of the daily attendance records was done. Total attendance was counted, as were diarrhea and dysentery cases, total sulfonamide treatments, diarrhea/dysentery cases given antibiotics, ORS or both during 1 month. There was a definite change in the treatment of diarrhea. The use of sulfonamides decreased consideably, from 76% in 1980 (pre ORT) to 22% in 1982 (after training). The use of ORS as the only treatment rose. From 8% in 1980 to 72% by 1982, 19 months after the training program.