Spatial variability in air pollution exposure in relation to socioeconomic indicators in nine European metropolitan areas: A study on environmental inequality.

A limited number of studies have addressed environmental inequality, using various study designs and methodologies and often reaching contradictory results. Following a standardized multi-city data collection process within the European project EURO-HEALTHY, we conducted an ecological study to investigate the spatial association between nitrogen dioxide (NO2), as a surrogate for traffic related air pollution, and ten socioeconomic indicators at local administrative unit level in nine European Metropolitan Areas. We applied mixed models for the associations under investigation with random intercepts per Metropolitan Area, also accounting for the spatial correlation. The stronger associations were observed between NO2 levels and population density, population born outside the European Union (EU28), total crimes per 100,000 inhabitants and unemployment rate that displayed a highly statistically significant trend of increasing concentrations with increasing levels of the indicators. Specifically, the highest vs the lowest quartile of each indicator above was associated with 48.7% (95% confidence interval (CI): 42.9%, 54.8%), 30.9% (95%CI: 22.1%, 40.2%), 19.8% (95%CI: 13.4%, 26.6%) and 15.8% (95%CI: 9.9%, 22.1%) increase in NO2 respectively. The association with population density most probably reflects the higher volume in vehicular traffic, which is the main source of NO2 in urban areas. Higher pollution levels in areas with higher percentages of people born outside EU28, crime or unemployment rates indicate that worse air quality is typically encountered in deprived European urban areas. Policy makers should consider spatial environmental inequalities to better inform actions aiming to lower urban air pollution levels that will subsequently lead to improved quality of life, public health and health equity across the population.

Is antibiotic prophylaxis in breast augmentation necessary? A prospective study.

BACKGROUND: The role of prophylactic antibiotics in breast augmentation remains controversial. However, the majority of surgeons are administering antibiotics. OBJECTIVE: To investigate the effect of antibiotic(s) use in the incidence of infection and capsular contracture following breast augmentation. METHODS: From September 2004 to November 2010, 180 patients underwent primary bilateral breast augmentation. They were prospectively divided into two equal groups: in group A (n=90), no antibiotics were given and, in group B (n=90), only one intravenous dose of cephalosporin was administered during the induction of general anesthesia. Preoperative data included age, body mass index, smoking status, medical history and implant volume. All operations were performed by the same surgeon using the same surgical technique and implant type. No drains were used. Operative data included operative time and estimated blood loss. Patients were evaluated for complications such as infection, hematoma and capsular contracture. The study concluded when all of the patients underwent the one-year follow-up. The Student's t test was used to analyze the results. RESULTS: All patients completed the study and both groups had similar demographic data. No differences in operative data were observed. The mean operative time was 35 min and the mean blood loss was found to be minimal. In group A, no implant infections were reported, while a wound infection that occurred was treated successfully with oral antibiotics. In group B, no implant or wound infection was noticed. No capsular contractures or hematomas were observed. CONCLUSIONS: The number of patients who underwent primary breast augmentation without antibiotics (n=90) was insufficient to draw any definitive conclusions. However, the present prospective study demonstrated that prophylactic use of antibiotics in breast augmentation had no significant effect on infection and capsular contracture rates. Further randomized clinical trials, in combination with guidelines from aesthetic plastic surgery societies, appear to be warranted.

HISTORIQUE: Le rôle de la prophylaxie antibiotique est controversé en cas d'augmentation mammaire. Toutefois, la majorité des chirurgiens en administrent. OBJECTIF: Examiner l'effet des antibiotiques sur l'incidence d'infections et de contractures capsulaires après une augmentation mammaire. MÉTHODOLOGIE: De septembre 2004 à novembre 2010, 180 patientes ont subi une augmentation mammaire primaire bilatérale. Prospectivement, elles ont été divisées en deux groupes égaux. Aucun antibiotique n'a été administré dans le groupe A (n=90), tandis que dans le groupe B (n=90), une seule dose de céphalosporine a été administrée par voie intraveineuse pendant l'induction de l'anesthésie générale. Les données préopératoires incluaient l'âge, l'indice de masse corporelle, le tabagisme, les antécédents médicaux et le volume des implants. Le même chirurgien a procédé à toutes les opérations, selon la même technique chirurgicale et à l'aide du même type d'implants. Il n'a pas utilisé de sonde. Les données opératoires incluaient la durée de l'opération et la perte de sang estimative. Les chercheurs ont évalué les patientes pour déterminer les complications telles que les infections, les hématomes et les contractures capsulaires. Ils ont mis fin à l'étude après une année de suivi auprès de toutes les patientes. Ils ont utilisé le test de Student pour analyser les résultats. RÉSULTATS: Toutes les patientes ont terminé l'étude, et les deux groupes présentaient des données démographiques similaires. Les chercheurs n'ont observé aucune différence à l'égard des données opératoires. L'opération durait 35 minutes en moyenne, et la perte de sang moyenne était minimale. Dans le groupe A, aucune infection des implants n'a été signalée, tandis qu'une infection de la plaie a été traitée par des antibiotiques par voie orale. Dans le groupe B, aucune infection des implants ou des plaies n'a été signalée. Aucune contracture capsulaire ni hématome n'a été observé. CONCLUSIONS: Trop peu de patientes ont subi une augmentation mammaire primaire sans prise d'antibiotiques (n=90) pour en tirer des conclusions définitives. Cependant, la présente étude prospective a démontré que la prophylaxie antibiotique en cas d'augmentation mammaire n'a pas d'effet significatif sur le taux d'infections et de contractures vasculaires. D'autres essais cliniques aléatoires, combinés à des lignes directrices des sociétés de chirurgie plastique, semblent justifiés.

Comparison of the distribution of citations received by articles published in high, moderate, and low impact factor journals in clinical medicine.

BACKGROUND: Whether the journal impact factor (JIF) indicator reflects the number of citations to an average article of a journal in different subject categories is controversial. We sought to further investigate this issue in general and internal medicine journals. METHODS: We selected to evaluate three journals of the above subject category, in each of three different JIF levels (high: 15.5-28.6, moderate: 4.4-4.9 and low: 1.6). Using the Scopus database, we retrieved the original research articles (after detailed screening) and review articles (as classified by Scopus) that were published in the selected journals in 2005 along with the number of citations they received in 2006 and 2007. We pooled the citations for articles of the same type in journals with the same JIF level into distinct variables. RESULTS: There was no marked association between the distribution of citations per article published in general medical journals and their JIF. All distributions studied were skewed to the right (higher number of citations). Specifically, 16-22% of the original research articles accounted for 50% of the total citations to this type of article for all three categories of studied journals; 34-37% of original research articles accounted for 75% of citations. The respective values for review articles were 12-18% and 29-39%. CONCLUSION: The distribution of citations received by articles published in high, moderate and low impact factor journals in clinical medicine seems similar. The JIF is not an accurate indicator of the citations the average article receives; articles published in low impact factor journals can still be highly cited and vice versa.

Reverse dorsal digital and intercommissural flaps used for digital reconstruction.

Reverse dorsal digital and intercommissural flaps offer a simple and versatile option for skin cover of distal finger defects, especially when other local flaps are not available. Twenty-one reverse dorsal digital flaps were used, on an outpatient basis, to cover dorsal soft tissue defects over or beyond the PIP joint. All the flaps were transposed as reverse island flaps. The average size of the defects was 2.5 cm(2) and they were all used to cover exposed tendon, bone, joint or a combination. Twenty flaps survived completely and did not present any feature of circulatory difficulty. Marginal necrosis of one flap was noticed, while two patients complained of swollen finger 6 months later. No morbidity was reported and the patients maintained good range of motion. Various other types of flaps that have been used to reconstruct distal digital skin defects are reviewed and compared with the reverse dorsal digital and metacarpal flaps.