The association between health service systems and pressure injury problems of individuals with chronic spinal cord injury in Malaysia, Indonesia, and Thailand: a cross-sectional study.

OBJECTIVES: To determine whether a health service system is an independent influencing factor of having pressure injury (PI) problems in individuals with chronic spinal cord injury (SCI) living in three countries. DESIGN: A cross-sectional study. METHODS: Data from the International Spinal Cord Injury Community Survey (InSCI) were analyzed. The PI problems were assessed using the Spinal Cord Injury Secondary Condition Scales (dichotomized to "having problem" and "not having problem". Health service systems were categorized as an inpatient-oriented SCI specialized system and a primary care-oriented system. A directed acyclic graph was applied to create a multivariable logistic regression model to determine the independent influencing factors of PI problems. RESULTS: Of 790 included participants, 277 (35%) had PI problems. Being recruited from countries with inpatient-oriented SCI specialized systems (Model 1) and visiting rehabilitation medicine/SCI physicians at least once a year (Model 2) is an independent negative correlating factor of PI problems (odds ratio = 0.569 [95%CI: 0.374-0.866] and 0.591 [95%CI: 0.405-0.864], respectively). CONCLUSION: SCI-specialized health service systems might be a protective factor of PI problems in middle-income country contexts. This result suggests the importance of having SCI-specialized services in middle-income countries to reduce the prevalence of PI problems.

The Effect of Laser Acupuncture on Spasticity in Children with Spastic Cerebral Palsy.

BACKGROUND: Spasticity in cerebral palsy is one of the most common disabilities of children in developing countries. OBJECTIVES: The objective of this study was to determine the efficacy of laser acupuncture on spasticity in children with spastic cerebral palsy. METHODS: This clinical trial was conducted on 60 patients with spastic cerebral palsy at 2 to 10 years. The patients were categorized into two groups: the control group and treatment group. Laser acupuncture was applied on GV20, GV14, LI4, GB34, and LR3 (power 50 mW, 785 nm, 1 Joule, 40 seconds) three times a week for 12 sessions in the treatment group and placebo laser acupuncture on the same points in the control group. The spasticity was measured using the Modified Ashworth Scale before and after complete sessions. RESULTS: The results showed that there was a significant reduction in the Modified Ashworth Scale score in the treatment group compared with the control group (p = 0.003). CONCLUSIONS: This study suggest that laser acupuncture on GV20, GV14, LI4, GB34, and LR3 can reduce spasticity for children with spastic cerebral palsy.

Cleft oronasal fistula: a review of treatment results and a surgical management algorithm proposal.

BACKGROUND: Oronasal fistulas (ONF) following cleft palate repair are commonly encountered and remain a challenging problem. With reported recurrence rates between 33% and 37%, this urges us to critically evaluate the current treatment and propose a surgical management protocol. METHODS: A retrospective study of patients treated for ONF by a single surgeon between 1995 and 2005 was performed. Data regarding cleft type, age at palate repair, complications, location and size of fistula, tissue condition, surgical technique employed, and success rate were gathered. RESULTS: There were 64 patients (33 male and 31 female), and 44% of them had bilateral cleft lip and palate. Hypernasality and regurgitation were the major presenting symptoms of these patients with ONF. Fistulas mostly occurred in the hard palate area (53.1%). Severe scarring surrounding the ONF was reported in 31.2% of patients. Local flap and two-flap palatoplasty were the most common techniques (62.5%) used for closure of the ONF. Twenty-five percent of patients needed more than one repair to close the fistula. However, the overall success rate of closure was high (90.5%). Velopharyngeal (VP) function was significantly improved: only 26.8% of patients had adequate VP function before ONF closure and 64.3% patients had adequate VP function after ONF closure. However, the VP function of twenty patients remained inadequate or marginal. CONCLUSIONS: A high success rate was achieved for closure of cleft ONF, although a certain percentage of patients required re-operation. Multiple fistulas and severely scarred palates made closure difficult. Successful closure of a fistula improved VP function but VP surgery was still indicated in certain patients. Based on the findings, an algorithm for management of cleft ONF was proposed.