Children at risk: risk factors for low back pain in the elementary school environment.

STUDY DESIGN: A prevalence survey of 101 randomly selected elementary schools in the Israel Central District. OBJECTIVES: To identify and describe risk factors for low back pain that exist in the elementary school environment. SUMMARY OF BACKGROUND DATA: Recent surveys report a high prevalence of low back pain in children and adolescents that increases with age, with a correlation between low back pain in adolescence and that experienced in adulthood. Environmental risk factors have been associated with the development of low back pain in children. Because of the significant amount of time children spend in their school environment, risk factors need to be identified in this environment. METHODS: A questionnaire, completed by school nurses, measured risk factors among 10,000 children in elementary schools in Israel. These included backpack and student weight, the availability of storage facilities, the appropriateness of chair and desk height to student height, seating arrangements during frontal lessons, and physical activity at recess. RESULTS: Between 30% and 54% of students carried >15% of their body weight. Nearly 15% of the first graders and 20% of sixth graders had inappropriate chairs. In 74% of the classes, students sat with their side facing the teacher and in 35% students sat with their backs. In 6% of schools, no physical activity is offered at recess. CONCLUSIONS: Shortcomings were found in all areas investigated. There is an urgent need for health promotion programs to increase awareness and reduce risks in the school environment.

Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics.

More than 20% of approximately 35,000 patients filling a diuretic prescription had no potassium blood test recorded within the previous year. A laboratory reporting system used throughout Israel by Maccabi Healthcare Services physicians was modified to provide physician alerts regarding potassium testing. The physicians were experienced users of a computerized medical record (CMR) that provided online laboratory test results. A nightly batch file checked pharmacy diuretic purchases against the patient's potassium blood test status. On-screen computer-generated reminders were sent to physicians of patients lacking a recent potassium test. Reminders to clinicians increased potassium testing by 9.8% (p < 0.001). Physician age and gender played a small part in predicting compliance to the alert, but specialty and practice size did not. The time delay between the date a reminder was sent and the potassium test date decreased steadily during the intervention. The success of this reminder system encourages expansion to include more drug-laboratory interactions. Furthermore, direct alerts to patients at multiple organization/patient contact points are planned.

Changing methods of imaging the common bile duct in the laparoscopic cholecystectomy era in Western Australia: implications for surgical practice.

OBJECTIVE: To assess changes in the use of endoscopic retrograde cholangiopancreatography (ERCP), intraoperative cholangiography (IOC), and surgical exploration of the common bile duct (CBD) associated with the introduction of laparoscopic cholecystectomy (LC). SUMMARY BACKGROUND DATA: The optimal strategy for dealing with potential stones of the CBD during LC remains controversial. METHODS: The authors conducted a population-based study of all cases of cholecystectomy (20,084) in Western Australia in the periods before, during, and after the introduction of LC (1988-1994). Index admissions were linked to previous or subsequent admissions for ERCP. Factors associated with ERCP were analyzed by multivariate regression models. RESULTS: Between 1988 and 1994, admissions for ERCP almost doubled, whereas the use of IOC decreased from 71% to 51%. Different trends were found for open and laparoscopic procedures. Exploration of the CBD declined because of the infrequent use of this procedure in LC. Preoperative ERCP was significantly more common in older patients and men; the reverse was found for IOC. There was an adjusted 3.5-fold increase in preoperative ERCP both during and after the introduction of LC. The adjusted odds ratios for IOC were 0.48 and 0.52 for these periods. CONCLUSIONS: The introduction of LC was associated with increasing reliance on ERCP to image the CBD and a decrease in the use of IOC. These changes were observed in both LC and open cholecystectomy. They suggest that the use of ERCP before cholecystectomy has partly replaced IOC for visualization of the CBD for suspected stones. Although more than 40% of patients undergoing LC had IOC, surgeons appear to be reluctant to perform surgical exploration of the CBD when stones are present. Savings in terms of both complications and cost can be expected if preoperative ERCPs performed for suspicion of uncomplicated CBD stones are replaced by IOC.