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PubMed1980

Avascular necrosis of the capitate and dorsal dorsi-flexion instability.

A vascular necrosis of the proximal part of the capitate is very rare and usually is secondary to a fracture of the waist in association with a scaphoid fracture---the naviculocapitate syndrome. A case is presented in which partial avascular necrosis of the capitate occurred in association with bilateral dorsal dorsi-flexion instability. The authors suggest that this phenomenon represents a form of the naviculocapitate syndrome in which ligamentous laxity altered the line of failure, thus sparing the scaphoid from fracture.

Adolescent↗
PubMed1995

Idiopathic avascular necrosis of the capitate.

Idiopathic avascular necrosis (AVN) of the capitate is rare. A 44-year-old woman presented with chronic pain in her dominant wrist without a history of trauma. Clinical and standard radiological examination were initially inconclusive, while MRI was diagnostic. Mid-carpal arthrodesis gave a satisfactory short term result, and the long term result is awaited. Idiopathic AVN of the capitate should be included in the differential diagnosis of chronic wrist pain.

Adult↗
PubMed2002

Ethnic identities, social capital and health inequalities: factors shaping African-Caribbean participation in local community networks in the UK.

This paper examines the impact of ethnic identity on the likelihood of peoples' participation in local community networks, in the context of recent policy emphasis on the participation of marginalised communities in such networks as a means of reducing health inequalities. Conceptually, the paper is located against the background of debates about possible links between health and social capital--defined in terms of grassroots participation in local community networks--and an interest in the way in which social exclusion impacts on social capital. The paper draws on lengthy semi-structured, open-ended interviews with 25 African-Caribbean residents of a deprived multi-ethnic area of a south England town. While African-Caribbean identity played a central role in peoples' participation in inter-personal networks, this inter-personal solidarity did not serve to unite people at the local community level beyond particular face-to-face networks. Levels of participation in voluntary organisations and community activist networks were low. Informants regarded this lack of African-Caribbean unity within the local community as a problem, saying that it placed African-Caribbean people at a distinct disadvantage--furthering their social exclusion through limiting their access to various local community resources. The paper examines the way in which the construction of ethnic identities--within a context of institutionalised racism at both the material and symbolic levels--makes it unlikely that people will view local community organisations or networks as representative of their interests or needs, or be motivated to participate in them. Our findings highlight the limitations of policies which simply call for increased community participation by socially excluded groups, in the absence of specific measures to address the obstacles that stand in the way of such participation.

Adolescent↗
PubMed2002

Risking risk: the influence of types of capital and social networks on the injection practices of drug users.

Although syringe exchange and other harm reduction interventions have generally been effective in reducing bloodborne pathogen incidence among injection drug users (IDUs), in some cases a minority of IDUs continues to engage in risky injection behavior. Building on emerging perspectives in social epidemiology and research on drug use in anthropology that point to the importance of examining fundamental social causes of risk behavior, or what puts individuals at risk for risk, this study used a multilevel perspective to explore whether forms of capital, social network characteristics, and other contextual factors influence continued risky injection behavior. Quantitative and qualitative data were collected on IDUs in the city of Marseilles, France, where sterile injection equipment has been legal and officially promoted since 1995. In multivariate analysis on data concerning active users, location in the densest part of a large, interconnected network of IDUs greatly increased the likelihood of risky injection practices, while there was a non-significant tendency for low Acquired Cultural and Economic Capital to predict this behavior. Among the strongest individual-level characteristics to predict this outcome were illicit use of prescribed medication, generally high dose buprenorphine, and unprotected sex. Parental abuse of psychoactive drugs during the subject's childhood, on the other hand, greatly decreased the chances of engaging in risky injection behavior. Additionally, qualitative data analysis suggests that risky injection may be linked to lack of resources to procure drugs, and not simply to inadequate sterile injection equipment. Further research, including ecological models, is needed to better understand how fundamental social conditions are related to "risk for risk". However, public health interventions can already address the need for community-level interventions, while rethinking the consequences of inaccessible drugs and unintended "leakage" from the introduction of buprenorphine and other medicalized treatments for opiate dependency.

Adult↗
PubMed2002

Economic role of solidarity and social capital in accessing modern health care services in the Ivory Coast.

At the beginning of the 1990s, health service reforms were implemented in public health institutions in most African countries South of the Sahara. In the Ivory Coast, the imposition of user fees for public services was adopted in 1994. Such fees require each person to have adequate financial resources in order to access modern health care services. Many poor people--despite their poverty--are able to access modern health care services that have become quite expensive. The factor that allows this access lies within the solidarity of parents, friends or members of a social network. In Africa, illness is a social phenomenon and a state of illness is negative. The sick human being is one who cannot fully participate in community life. The treatment of a sick person is, then, an act, which is tied to the systems of life, which are produced and maintained collectively. Once the causes of illness are identified and consequences evaluated, it is the entire family or group that participates in the finances which bring about treatment. In this study, we show the role of social capital in the processes of financial solidarity for access to modern health care services that now require payment. Our investigation provides valuable insights on the role of social capital with respect to social strategies and community financing mechanisms for the acquisition of modern health care in Africa.

Attitude to Health↗
PubMed1996

Proximal row carpectomy with partial capitate resection.

Twelve patients who had undergone proximal row carpectomy with partial resection of the capitate were reviewed. Ten patients had degenerative arthritis secondary to scapholunate advanced collapse deformity or chronic scaphoid nonunion. Seven of these patients had significant lunocapitate and three had radiolunate degenerative disease. An additional two patients underwent an immediate modified proximal carpectomy for acute complex radiocarpal trauma. At follow-up evaluation after a mean of 55 months, seven patients reported no pain and four patients had only occasional pain with strenuous activity. There was a trend toward increase of the total active flexion/extension arc, from 80 degrees before to 94 degrees after operation. The improvement in flexion from 38 degrees to 46 degrees was significant (p = .01). In the final four patients, who also had interposition of the dorsal capsule, however, the final arc of motion averaged 111 degrees. Grip strength improved from 19 to 26 kg following surgery. This strength gain was statistically significant (p = .01 by paired t-test analysis). The favorable results of this partial capitate resection technique may be due to a broader distribution of radiocarpal compression forces. Interposition of the thickened dorsal capsule may also contribute to an improved radiocarpal interface. The intermediate-term results of this review would suggest that lunocapitate and radiolunate disease need not contraindicate a modified proximal row carpectomy.

Adult↗
PubMed1999

A trans STT, trans capitate perilunate dislocation of the carpus. A case report.

We report a case of carpal injury not previously described, associating three lesions of the carpus secondary to a hyperextension mechanism: fracture of the capitate, scapho-trapezio-trapezoid sprain and lunotriquetral ligament rupture. The patient was operated by percutaneous pinning after closed reduction. The capitate fracture was not fixed. At follow-up, the patient had no restriction of his everyday activities and was very satisfied.

Carpal Bones↗
PubMed2004

Variations in the use of emergency departments in Alberta's Capital Health region 1998-2000.

The objectives of this study were to describe the utilization of emergency departments in the Capital Health region, Alberta, between 1998 and 2000, and temporal variations in emergency department utilization by month, day of week, and time of day in 2000. Between 1998 and 2000, the annual number of visits to emergency departments in the region increased by six percent. The mean length of stay, median length of stay and the number of patients who left without being seen increased by six minutes, eight minutes, and 4,442 patients respectively. Variations in the number of visits, mean and median lengths of stay, and numbers of patients who left without being seen by month, day of week, and time of day were modest except for patients who left without being seen. Service pressures in Capital Health emergency departments continue to exist. Temporal variations in service pressures were small. Causes of emergency department pressures are multiple and interrelated. Therefore, system-wide changes should be considered in addressing emergency department pressures.

Adolescent↗
PubMed2002

Adaptive user interface customization through browsing knowledge capitalization.

Hypermedia data browsing is a mean for improving information access. However, the overload and the heterogeneity of medical information, as well as the multitude of possible navigational paths, turn the consultation of data into a difficult task. We present in this paper a solution for the development of adaptive user interfaces in a hypermedia data browsing environment. It is based on the capitalization of the users knowledge in the decision-making process, expressed in terms of navigational paths and of data presentation modes that are customized to the user's preferences and practice. This capitalization offers the user a way to automatically store and reuse the experience accumulated in browsing through patient records. We illustrate our approach with the implementation of HEMA, a clinical workstation prototype that we have specialized for the cardiology domain.

Artificial Intelligence↗
PubMed2003

"Fair shares": beyond capitalism and socialism, or the biological basis of social justice.

The accumulating scientific evidence -- across many disciplines -- regarding human evolution and the dualities and complexities of human nature indicates that the core ideological assumptions of both capitalism and socialism are simplistic and ultimately irreconcilable. A biologically grounded approach to social justice enables us to articulate a new ideological paradigm that I call ''Fair Shares.'' This paradigm consists of three complementary normative principles. First, goods and services should be distributed to each according to his or her basic needs. Second, surpluses beyond the provisioning of our basic needs should be distributed according to merit. And, third, each of us is obliged in return to contribute to the ''collective survival enterprise'' in accordance with his or her ability. Though none of these three principles is new, in combination they provide a biologically informed middle way between capitalism and socialism. Some of the many issues that are raised by this formulation are also briefly addressed.

Journal Article↗
PubMed2001

Access to mental health services and health sector social capital.

Mental health services are underused relative to mental illness rates. We hypothesized a positive correlation between use of mental health services and community-level health care social capital. Community Tracking Study data from 43 cities (N = 43,278), merged with the National Profile of Local Health Departments and other sources, show that use of mental health services was greater when public health districts collaborated with managed care organizations and other community groups, independent of individual predictors and health care system variables. Use was also positively associated with community levels of public insurance coverage and with direct public health provision of behavioral health care services. Research is needed to understand the mechanisms by which social capital may improve access to mental health services.

Adult↗
PubMed2003

Social capital and premarital sexual activity in Africa: the case of Kinshasa, Democratic Republic of Congo.

Prior research has pointed to several factors that may affect sexual behavior in Africa, but much of the work has been atheoretical or descriptive, thus reducing the explanatory value of some findings. In this study, the influence of individual characteristics and family background were examined in a sample of 2,000 women aged 14-24 interviewed in Kinshasa in 1995. The analysis was guided by the social capital framework and the discussion focused on three theoretical perspectives: rational adaptation, social disorganization, and patrilineal bias. The results from the event history analysis showed that poverty, exposure to mass media, patrilinearity, and AIDS awareness greatly reduce the risk of premarital sexual activity. In contrast, social capital, as measured by the number of siblings, was positively associated with sexual permissiveness, suggesting a dilution of adults' attention to children in larger families.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Comparison of compensation and capitalization models when treating suicidality in young adults.

The current study examined compensation and capitalization treatment models with specific reference to problem-solving appraisal and problem-solving treatment of suicidal behavior (M. D. Rudd, T. Joiner, & M. H. Rajab, 2000). A sample of 98 young adults (mean age = 22), who had recently attempted suicide or ideated about suicide to the degree that they came to clinical attention, were randomly assigned to either problem-solving or control treatment. Participants with poorer problem-solving appraisal at baseline responded better than did participants with greater problem-solving appraisal to problem-solving treatment at 6-month follow-up, as would be predicted by the compensation model. Results suggest that treatment of suicidality for individuals with problem-solving skill deficits may be most effective by targeting these deficits rather than capitalizing on strengths.

Adult↗
PubMed1999

Isolated nondisplaced capitate waist fracture diagnosed by magnetic resonance imaging.

Isolated capitate fractures are rare and may be underdiagnosed, especially when fracture displacement is minimal or absent. Our case report of a nondisplaced capitate waist fracture exemplifies the need for careful evaluation because initial plain radiographs were considered normal and appropriate treatment was delayed. This report also documents the use of magnetic resonance imaging in diagnosing such fractures.

Adult↗
PubMed2002

Prevalence and risk factors for asthma and chronic bronchitis in the capitals Helsinki, Stockholm, and Tallinn.

The aim of this part of the FinEsS-studies was to assess whether differences existed in prevalence of asthma, chronic bronchitis, and respiratory symptoms between three Baltic capitals, and to examine risk factor profiles for respiratory conditions. In 1996, a postal survey was performed in these cities with a response rate of 72% in Stockholm, 76% in Helsinki, and 68% in Tallinn. The prevalence of physician-diagnosed asthma was 76% in Stockholm, 6.2% in Helsinki, and 2.3% in Tallinn, while respiratory symptoms were most common in Tallinn. The prevalence of physician-diagnosed chronic bronchitis was 10.6% in Tallinn, 3.4% in Helsinki, and 3.0% in Stockholm. Risk factor analyses revealed a significantly increased risk for those living in Tallinn compared to that of Stockholm for wheezing conditions, OR 1.56-1.69, longstanding cough, OR 1.92 (1.74-2.13), attacks of shortness of breath during the previous 12 months, OR 1.35 (1.20-1.52), and chronic productive cough, OR 1.49 (1.28-1.74). Subjects having symptoms common in asthma were more likely to have physician-diagnosed asthma in Stockholm and Helsinki than in Tallinn, while subjects having bronchitis symptoms had more often physician-diagnosed chronic bronchitis in Tallinn. Prevalence of respiratory symptoms was higher in Tallinn than in Stockholm and Helsinki, while physician-diagnosed asthma was more common in Stockholm and Helsinki. The prevalence of physician-diagnosed chronic bronchitis was three times as high in Tallinn as in Helsinki or Stockholm. Our results also suggest large differences in diagnostic practices between the three countries, while the differences between the capitals in true prevalence of disease may be small.

Adult↗
PubMed2003

[Functional results two years after the treatment of a delayed diagnosed scapho-capitate fracture syndrome].

The scapho-capitate syndrome (Fenton syndrome) is so rare that diagnosing is a real challenge to every clinician. Therefore, its primary treatment is not always possible. In this case we are reporting about a delayed open treatment of a Fenton syndrome ten days after the original injury. Open reduction was performed via a dorsal approach and the capitate fracture was stabilized with K-wires and the scaphoid fracture with screw fixation. After postoperative immobilization of the wrist using an external fixator for six weeks the patient was already able to work again only twelve weeks after surgery.

Adult↗
PubMed2005

Cytological development and sesquiterpene lactone secretion in capitate glandular trichomes of sunflower.

The secretion of sesquiterpene lactones (STL) in capitate glandular trichomes from the anther appendages of Helianthus annuus L. (Asteraceae) was observed by light and fluorescence microscopy and HPLC analysis. Disk flowers within the sunflower capitulum showed the known ontogenetic progression from the centre to the margin. During development of the florets, the trichomes in the anther appendages secreted their metabolites into the subcuticular secretion storage space in front of the two apical cells. All stages of forming the cuticular globe, from the pre-secretory to the post-secretory phase, could be observed microscopically and secretory activity was simultaneously monitored. Six germacrolides and heliangolides of known structure were selected for quantitative analysis. The increase in STL content during extension of the subcuticular space was monitored by HPLC analysis. Thereby, the start and termination of STL biosynthesis was defined in relation to other developmental stages of floret ontogenesis, particularly, the pollen formation. Part of the secreted material showed autofluorescence which could be attributed to a hydroxy-trimethoxy-flavone, as determined by NMR and mass spectroscopy. The anther trichomes were cytologically and chemically similar to foliar glandular trichomes of sunflower and represent the multicellular capitate glandular trichome type common to many Asteraceae. The ease with which anther trichomes of H. annuus can be harvested and analyzed suggests that they can provide a valuable model system for investigation of STL and flavonoid metabolism in Asteraceae.

Flowers↗