Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe.

A retrospective facility-based costing study was undertaken to estimate the comparative cost per visit of five integrated sexual and reproductive health and HIV (human immuno-deficiency virus) services (provider perspective) within five clinic sites. These five clinics were part of four service delivery models: Non-governmental-organisation (NGO) directly managed model (Chitungwiza and New Africa House sites), NGO partner managed site (Mutare site), private-public-partnership (PPP) model (Chitungwiza Profam Clinic), and NGO directly managed outreach (operating from New Africa House site. In addition client cost exit interviews (client perspective) were conducted among 856 female clients exiting integrated services at three of the sites.

Prevalence and correlates of herbal medicine use among Anti-Retroviral Therapy (ART) clients at Queen Elizabeth Central Hospital (QECH), Blantyre Malawi: a cross-sectional study.

Background: There has been an unprecedented explosion in the popularity of herbal preparations during the last few decades. Herbal medicines are commonly used by HIV/AIDs clients. There is limited data on the prevalence of herbal medicine and correlating factors of herbal medicine use in Malawi.

Warfarin Anticoagulation and Fetal Central Nervous System Abnormalities: a Case Report.

Background: Anticoagulation of pregnant woman with mechanical prosthetic heart valves is associated with significant maternal and fetal risks.

Methods: We describe a case of dorsal midline dysplasia in a fetus at 11 weeks' gestation. The mother was receiving warfarin therapy at a dose of 7.

Conservative Management of Overanticoagulation in Patients With Low-Moderate Risk for Bleeding Complications.

Despite long-standing experience with warfarin, anticoagulation clinic services are often confronted with the challenging clinical situation of patients with overanticoagulation. This requires repeat international normalized ratio (INR) monitoring and in some cases administration of vitamin K to minimize the risk of bleeding. A study was performed to determine the safety and efficacy of outpatient management in order to provide guidance on the management of patients with prolonged INRs.

Predictors of warfarin dose requirements in South African patients attending an anticoagulation clinic.

Introduction: Warfarin is the most common oral anticoagulant for the treatment and prevention of thromboembolic disease. However, it has a wide interpatient variability in dose requirements due to various genetic and clinical factors.

Materials And Methods: This study investigated the effect of clinical and genetic factors on the variability of warfarin dose requirements in 147 South African patients (81 white and 66 black).

All black people are not alike: differences in HIV testing patterns, knowledge, and experience of stigma between U.S.-born and non-U.S.-born blacks in Massachusetts.

Non-U.S.-born black individuals comprise a significant proportion of the new diagnoses of HIV in the United States.

Systematic review and meta-analysis of interventions relevant for young offenders with mood disorders, anxiety disorders, or self-harm.

Background Mood and anxiety disorders, and problems with self-harm are significant and serious issues that are common in young people in the Criminal Justice System. Aims To examine whether interventions relevant to young offenders with mood or anxiety disorders, or problems with self-harm are effective. Method Systematic review and meta-analysis of data from randomised controlled trials relevant to young offenders experiencing these problems.

Is diabetes a coronary risk equivalent? Systematic review and meta-analysis.

Aims: To determine whether patients with diabetes without prior myocardial infarction (MI) have the same risk of total coronary heart disease (CHD) events as non-diabetic patients with previous myocardial infarction.

Methods: Using MEDLINE, EMBASE, Cochrane and MeSH in this systematic review and meta-analysis, extensive searching was carried out by cross-referencing from original articles and reviews. The study consisted of cohort or observational studies with hard clinical endpoints, including total CHD events (fatal or non-fatal myocardial infarction), stratified for patients with diabetes but no previous myocardial infarction, and patients without diabetes but with previous myocardial infarction.

Age threshold for vascular prophylaxis by aspirin in patients without diabetes.

Objective: To determine an appropriate age threshold at which to prescribe aspirin for primary cardiovascular disease (CVD) prevention among men and women without diabetes.

Design: Cross-sectional study.

Setting: 304 general practices in England and Wales contributing to The Health Improvement Network (THIN) electronic patient files.

Do young patients with malunited fractures of the distal radius inevitably develop symptomatic post-traumatic osteoarthritis?

Fractures of the distal radius occurring in young adults are treated increasingly by open surgical techniques, partly because of concern that failure to restore the alignment of the fracture accurately may cause symptomatic post-traumatic osteoarthritis in future years. We reviewed 106 adults who had sustained a fracture of the distal radius between 1960 and 1968 and who were below the age of 40 years at the time of injury. We carried out a clinical and radiological assessment at a mean follow-up of 38 years (33 to 42).

Acceptance of HIV screening in an antenatal population at a referral teaching hospital in Zimbabwe: a substudy of an operational research in prevention of mother to child HIV vertical transmission.

Objective: To determine the acceptance of HIV testing by pregnant women referred to the antenatal clinic at a tertiary training hospital. Women who accepted testing and were positive received nevirapine. Their babies also received nevirapine within 72 hours of birth.

Serum urea and total cholesterol independently predict re-hospitalisation with a cardiac-related event following an acute ST-elevation myocardial infarction.

Background: Although elevated serum urea and low serum sodium have been shown to be associated with increased short-term (30-day) mortality following an ST-elevation myocardial infarction (STEMI), little is known about the role of these biochemical markers as predictors of intermediate-term (1-year) re-hospitalisation.

Methods: Case notes of 90 consecutively admitted patients discharged with a primary diagnosis of an STEMI were retrospectively investigated. Baseline parameters were recorded and patients' clinical course following hospital discharge was carefully reviewed up to 1-year post-STEMI.

Comparison of oral amoxicillin and intravenous benzyl penicillin for community acquired pneumonia in children (PIVOT trial): a multicentre pragmatic randomised controlled equivalence trial.

Objective: To ascertain whether therapeutic equivalence exists for the treatment of paediatric community acquired pneumonia by the oral and intravenous (IV) routes.

Methods: A multicentre pragmatic randomised controlled non-blinded equivalence trial was undertaken in eight paediatric centres in England (district general and tertiary hospitals). Equivalence was defined as no more than a 20% difference between treatments of the proportion meeting the primary outcome measure at any time.

Combining population health and baseline risk strategy by determining an age cutoff for initiating statins in patients with diabetes: a population-based study.

Objective: Strategies for initiating statin use among adult patients with diabetes for primary cardiovascular disease (CVD) prevention include treating all patients (assuming diabetes is a coronary risk equivalent) or treating patients who are at risk of developing CVD. The aim of the study was to combine both strategies to derive an appropriate age cutoff for prescribing statins. By considering different strategies, we also aim to assess the effectiveness and efficiency of different strategies to reduce CVD events.

Clinical outcome of symptomatic unilateral stress injuries of the lumbar pars interarticularis.

Study Design: A prospective case-series study.

Objective: To evaluate the results of nonoperative and operative treatment of symptomatic unilateral lumbar pars stress injuries or spondylolysis.

Summary Of Background Data: Most patients become asymptomatic following nonoperative treatment for unilateral lumbar pars stress injuries or spondylolysis.

The internal consistency and validity of the Patient Evaluation Measure for outcomes assessment in distal radius fractures.

The internal consistency and validity of the Patient Evaluation Measure (PEM) was investigated in the setting of the distal radius fracture by assessing 200 patients 6 to 42 years after injury using the PEM and DASH questionnaires and objective measures of outcome. The PEM was completed separately for both the injured and uninjured wrist. We found highly significant correlations between the PEM and objective measures and, also, between the PEM and DASH scores.

Validity of 13C octanoic acid breath test for measurement of solid meal gastric emptying time in children.

Background/purpose: It is important to establish a physiologic range of gastric emptying (GE) in children. Gastric emptying time measured with (99)Tc-labeled solid meal (GE(Tc)) is the gold standard. Large-scale studies with GE(Tc) are ideal but not feasible because of radiation exposure.

Preservation of the ulnar bursa within the carpal tunnel: does it improve the outcome of carpal tunnel surgery? A randomized, controlled trial.

Background: It was hypothesized that preserving a layer of gliding tissue, the parietal layer of the ulnar bursa, between the contents of the carpal tunnel and the soft tissues incised during carpal tunnel surgery might reduce scar pain and improve grip strength and function following open carpal tunnel decompression.

Methods: Patients consented to randomization to treatment with either preservation of the parietal layer of the ulnar bursa beneath the flexor retinaculum at the time of open carpal tunnel decompression (fifty-seven patients) or division of this gliding layer as part of a standard open carpal tunnel decompression (sixty-one patients). Grip strength was measured, scar pain was rated, and the validated Patient Evaluation Measure questionnaire was used to assess symptoms and disability preoperatively and at eight to nine weeks following the surgery in seventy-seven women and thirty-four men; the remaining seven patients were lost to follow-up.

Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state.

Obstructive sleep apnoea (OSA) is a cardio-metabolic disorder. Whether metabolic syndrome (MS), insulin resistance (IR) and albuminuria are independently associated with OSA is unclear, but defining the interactions between OSA and various cardiovascular (CV) risk factors independent of obesity facilitates the development of therapeutic strategies to mitigate their increased CV risks. We prospectively recruited 38 subjects with OSA and 41 controls.

A prospective objective study of the cosmetic sequelae of nasal septal surgery.

Conclusions: Following nasal septal surgery, minor aesthetic changes may occur in up to 39.5% of patients and major changes in up to 4.5%.

Do anterior interbody cages have a potential value in comparison to autogenous rib graft in the surgical management of Scheuermann's kyphosis?

Background Context: Previous studies have analyzed the outcome following posterior correction and combined anterior-posterior correction for Scheuermann's kyphosis. Traditionally interbody fusion has been obtained using morselized rib graft. Recently the use of titanium anterior cages has been suggested for interbody use.