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[Who would suffer this child in the cold? History and diagnosis during a Socratic dialogue].

This article gives an account of the experiences of 12 dentists (11 general practitioners and one periodontist) during a one-day Socratic dialogue, which took place at the International Conference for Dentists in Bruges 2001. The key question was: "When must I (or mustn't I) comply with the patient's wish?" The participants tackled an example from Edgar, general practitioner. His story went like this: on Christmas Eve, dinnertime, one of his patients--duly instructed beforehand--arrived just like that, and said: "I'm in pain". When the central question was applied to this example, uncertainty arose about the exact nature of "the patient's wish". In this article you read how the participants dealt with the "pain", with the uncertainty.

Communication↗

How to Map Noise.

Noise mapping is a method of presenting complex noise information in a clear and simple way either on a physical map or in a database. This mapping information can be either calculated or measured using a variety of techniques and methods. Furthermore, the results of such exercises can be presented in many different ways and used for a number of different purposes. This paper attempts to examine these issues in the light of the "mapping requirements" outlined in the recently proposed Directive of the European Parliament and of the Council, relating to the Assessment and Management of Environmental Noise (Comm (2000) 468 final). This proposed Directive was laid before the Parliament and Council in the autumn of 2000. The First Reading of the proposal was successfully negotiated just before Christmas 2000. The Second Reading is likely to commence shortly.

Journal Article↗

Audit of emergency medical admissions during the winter 1997/1998.

OBJECTIVES: To test the hypothesis that a significant cause of rising medical admissions over the Christmas and New Year period is the failure of social and medical systems which support patients at home for most of the year; and to understand the reasons for admission during the winter months of an at risk population and to identify possible avoidable admissions. DESIGN: Structured interviews were conducted with patients within 48 hours of admission to collect information on home circumstances and contact with social, medical and primary care in the year prior to admission. In cases where the patient was unable to provide this information, case notes and nursing notes were reviewed. Discharge diagnosis was recorded at the end of the study period. SUBJECTS: Five hundred and thirty nine patients defined as an "at risk group" who were admitted to hospital as emergency medical admissions between 1st December 1997 and 31st January 1998. RESULTS: Subjects were predominantly female (58%). The major diagnostic groups were cardiac (27%) and respiratory (22%). Respondents indicated no change in primary care in the period preceding their admission, with the exception of day centre support. Sixty seven percent of patients fully interviewed received help from carers, friends or relatives with daily tasks and only seven (3%) reported receiving less input prior to admission. Forty five percent of these patients had seen a GP within the month prior to their admission. CONCLUSIONS: The study results showed no breakdown in either social or family support. In the group interviewed, the proportion who had experienced any decrease in social support during the period prior to admission was very small.

Aged↗

A case of indirect exposure to cat at school.

Indirect exposure to cat allergens may exacerbate asthma in sensitized subjects. We report a case of a 13-year-old girl referred to our Unit for cough, dyspnea, wheezing, chest tightness, nasal itching and obstruction during the past six months, with improvement during summer holidays. Skin prick tests were positive for cat and Alternaria alternata. She had no cats at home. Spirometry was normal and methacoline bronchial challenge was negative. PEF monitoring showed a mean value of 80% of the predicted value with a variability higher than 20% in a few occasions. At a follow up visit PEF recording showed an increase of 80 litres/min during a 2 weeks Christmas holidays, and a subsequent reduction after being back at school. At a further questioning we found that in her class there was a girl who owned 23 cats. It is likely that PEF and symptoms in our patient were affected by indirect cat exposure at school.

Adolescent↗

[Beta-blocking drugs indicated in patients with heart failure].

Until recently, beta-blocking drugs were considered to be contraindicated in patients with chronic heart failure. However, several well-conducted randomised clinical trials have now proven otherwise. Yet, it was still not clear whether nonselective alpha-, beta 1- and beta 2-receptor blockade with carvedilol would be superior to selective beta 1-receptor blockade with metoprolol. One of the studies ('Carvedilol or metoprolol European trial' (COMET)) demonstrated a statistically significant 17% reduction of all-cause mortality with carvedilol. Although striking, the results may have been influenced by differences in blood pressure and heart rate, as well as the short-acting formula of metoprolol that was used. Furthermore, the 'Carvedilol hibernation reversible ischaemia trial; marker of success' (CHRISTMAS) study demonstrated myocardial hibernation in the majority of ischaemic heart-failure patients, and showed beneficial effects on left-ventricle function with carvedilol in both hibernated and non-hibernated patients. Despite this and the rest of the overwhelming evidence, at present only a minority of eligible chronic heart-failure patients are treated with beta-blockers.

Adrenergic beta-Antagonists↗

An unusual complication in a gravida with factor IX deficiency: case report with review of the literature.

Factor IX deficiency (hemophilia B, Christmas disease) is an X-linked recessive coagulation disorder. It occurs in one out of every 25,000-30,000 male births and requires even rarer genetic circumstances for phenotypic expression in females. We report the occurrence of a large, late-trimester subchorionic hematoma in a gravida with factor IX deficiency and with laboratory evidence of consumptive coagulopathy during treatment. The patient was managed conservatively and had a successful outcome at term. The only four reported cases of antepartum management of factor IX deficiency in the English literature are reviewed.

Adolescent↗

Ophthalmomyiasis in Hawaii.

Ophthalmomyiasis is the infestation of the eye by fly larvae. Commonly caused by Oestrus ovis, a female sheep botfly will accidentally deposit her larvae into a human eye, resulting in disease. Prompt recognition and treatment of this condition will improve patient care and reduce potential complications. We report a case of ophthalmomyiasis in a young man from Molokai who was infested while unloading a Christmas tree.

Adolescent↗

Sewage-treatment under substantial load variations in winter tourism areas--a full case study.

The sewage-load variations in winter tourism areas are characterized by sudden increases--in the range of a factor two to three--within only a few days at the start and the end of the tourist season, especially at Christmas. The sudden load increases occur during periods of low wastewater temperatures, which is an additional demanding factor with respect to nitrogen removal. A full case study was carried out at WWTP Saalfelden, which is located near one of Austria's largest skiing resorts. The plant is designed for 80,000 PE and built according to the HYBRID-concept, which is a special two stage activated sludge process for extensive nutrient removal.

Austria↗

[Psychiatrist Johann Christian August Heinroth's (1773-1843) practical work at St George's prison, orphanage and madhouse in Leipzig].

This paper ventures to give insights into and evaluate HEINROTH's practical work as a doctor at Leipzig's Georgenhaus on the basis of primary sources found at Leipzig and other Saxony archives. The analysis shows that HEINROTH took up this post because of financial needs. Hence there arose a conflict between this job at the city's orphanage and madhouse and HEINROTH's real ambition of becoming a professor of psychiatry at Leipzig University. THis continued for the whole of his time there. HEINROTH undertook an extremely responsible role and worked energetically at St George's from 1814 until 1834; almost the entire medical care of the 600 inmate lay in his hands. HEINROTH cannot be held responsible for the failure to reform the mental health care system, though urgently needed. On the contrary, he made every effort to ease his patients' mental anguish and life at St George's. However, it must be pointed out that HEINROTH entrusted to his assistants a great part of his duties. HEINROTH did not always fulfil his duties at the local prison to the agreed extent. Increased tensions between him and authorities led to mutual recriminations which ultimately resulted in HEINROTH's dismissal at Christmas 1833. No final judgement can be made as to what extent the arguments propounded by both parties were justified.

Germany↗

Hemophilia B and free tissue transfer: medical and surgical management.

Hemophilia B (Christmas disease) is a rare, X-linked bleeding diathesis, which may present with life-threatening hemorrhage. Management of the coagulopathy in the setting of free tissue transfer may be particularly challenging. The authors present the first case in the English literature of a male with hemophilia B undergoing microvascular free flap reconstruction, as well as a review of the current surgical and medical management of hemophilia B. Based upon this experience, perioperative specific factor replacement is recommended. Given physiologic trough levels of the replaced factor, routine antiplatelet therapy appears appropriate. Management of free tissue transfer in the setting of severe hemophilia is significantly more challenging and should benefit from multidisciplinary coordination.

Aged↗

Pityriasis rosea with palmoplantar plaque lesions.

Pityriasis rosea is a skin disease characterized by sharply defined pruritic red patches covered by fine scales. It affects mostly adolescent and young adults. Typical lesions usually affect the trunk in a Christmas-tree pattern. The eruption usually resolves after 6 weeks but symptomatic treatment may be needed. Two patients are reported with classic presentation of pityriasis rosea except for the unusual associated palmoplantar lesions; both patients had negative RPR (with dilutions) and MHA-TP. They responded to 2-week courses of either oral erythromycin or Clarithromycin with complete resolution.

Adult↗

Do people with cancer postpone death to celebrate special occasions?

Several researchers have claimed that a connection exists between deathdays and birthdays or other special occasions. Some people, especially women, appear to postpone death until after their birthdays or other special occasions to celebrate these events one more time. The purpose of this retrospective study was to determine if a deathday-birthday or deathday-Christmas connection was evident in cancer-related deaths. Data were obtained from the Rochester (New York) Regional Tumor Registry (N = 2566), the New York State Cancer Registry (N = 50,562), and the Ohio State Department of Health (N = 73,907) for three samples of individuals who died from cancer. Only a few deathday-birthday connections were evident. However, these connections were not replicated across states and years.

Anniversaries and Special Events↗

Seasonality of births in Croatia.

The aim of this paper was to investigate seasonal fluctuations of the number of births in Croatia. Vital registration data from the years 1970-2002 was used for analysis of the quarterly data (from the years 1970-1997), and monthly data (from the years 1998-2002). Both data sets were smoothed, using seasonal variation removal for quarterly data, and T4253H smoothing for monthly data. Edwards test and Ratchet circular scan tests were used in analysis. The results showed an increase in the summer birth proportion and decrease in the spring birth proportion, distorted during the wartime period (1991-1995). Monthly analysis reveals highest birth proportion in Croatia during July-September period, with peak date moving towards the end of summer, and reaching stability in the beginning of September during the years 2000-2002. This presumes highest conception rate during the beginning of the Christmas holiday season. Secondary peak in January was found in some years, which presumably sets second period of increased conception rate into the Easter holiday season, supporting the observation of the holiday-related birth peaks. Both quarterly and monthly data indicate a birth pattern that does not resemble either "European", or "American" seasonal pattern. Regional analysis showed lack of seasonality in the capital city of Zagreb and either intermittent or stable seasonality pattern in the rest of the country.

Adult↗

[The effect of public holidays on the suicide drive (frequency) in Hungary (1970-2002)].

INTRODUCTION: The aim of the study was to examine the relationship between suicide frequency and the days of the week and major public holidays in Hungary (1970-2002). The analysis was based on data of approximately 140,000 suicides. The authors intended to examine whether the "broken promise effect" (Gabennesch), which is cited with increasing frequency in the literature, is valid also in Hungary or not. RESULTS: Suicides occur most frequently on Monday and least on weekends for both males and females. On the days of Christmas and Easter the suicide drive has decreased among males only. The first day of the year is associated with a large increase of suicide risk in both genders, while there appears to be no change in suicide-frequency on the public holidays of 1st May and 20th August. CONCLUSIONS: The findings of our study confirm the validity of the "broken-promise effect" theory also under Hungarian circumstances. It is a very important to know that suicides do not show an increase on and before weekend and public holidays, but after the following day(s). This finding can be an important aspect when preventive measures are adopted.

Adult↗

The Universal Oxygen Connector.

The purpose of this article is to describe the benefits of using the Universal Oxygen Connector. Until now, an oxygen hose was only able to connect to a 22-mm fitting, such as those found on humidifiers used in the recovery room, and oxygen tubing was only able to connect to a Christmas tree type adapter. The Universal Oxygen Connector, manufactured and sold by International Medical, Inc (Burnsville, Minn), was developed to allow the practitioner to attach either a 22-mm oxygen hose, oxygen tubing, or a 15-mm oxygen adapter to the same connector. Patients benefit from the administration of supplemental oxygen in the perioperative period. Supplemental oxygen has been shown to decrease postoperative hypoxemia, infection, and in some cases, nausea and vomiting. As such, oxygen should be administered during transport from the operating room to the recovery room, in the recovery room, and at times during transport to the patient room and in the patient room. Oxygen also should be administered whenever a patient receiving oxygen is transported. Use of the Universal Oxygen Connector decreases material waste, decreases hospital costs, saves time and effort and, most importantly, promotes patient safety by providing a versatile system for oxygen delivery.

Cost-Benefit Analysis↗

Cardiac arrest: a late complication of glucose-insulin-potassium (GIK) therapy.

Rebound hyperkalaemia 4 hours after discontinuation of a glucose-insulin-potassium infusion inhibited an already compromised conduction system leading to ventricular standstill in a 41 year old man after re-do aortic valve surgery. Resuscitation was successful and allowed him to return from Australia to his home on Christmas Island. Glucose-insulin-potassium (GIK) infusions to reduce myocardial hypo-/re-perfusion injury after myocardial infarction, during coronary artery surgery and cardiopulmonary bypass are becoming more popular. There may also be a role for GIK in the treatment of refractory dysrhythmias and for myocardial protection in the brain-dead patient. However, these infusions are not without hazard and this report of rebound hyperkalaemia and cardiac arrest is unlikely to remain isolated.

Journal Article↗

[Chikungunya fever in La Reunion Island--2006].

The epidemic of Chikungunya fever that has affected the population of La Reunion since Christmas 2005 will be remembered as the most serious public health crises in the island's history. A number of lessons have been learned from this experience with a disease initially considered as benign. In addition to providing a concise chronological account of epidemiological events from the beginning of the outbreak in March 2005, this article describes what was done, what has been learned up to now, what could have been done and what remains to be done. After this outbreak Chikungunya fever can no longer be considered as transient strictly benign disease. Nor can the population or authorities of La Reunion ever again consider that economic development protects them from the hazards of the tropical environment.

Alphavirus Infections↗

Toys and safety.

Christmas is coming and with it the purchase of toys for the children. But toys are also given all year round, and educating each new generation of parents about toy and play safety is part of the public health role for health professionals working with families.

Child↗