Socio-economic status and lifestyle factors are associated with achalasia risk: A population-based case-control study

AIM: To evaluate the association between various lifestyle factors and achalasia risk.METHODS: A population-based case-control study was conducted in Northern Ireland, including n = 151 achalasia cases and n = 117 age- and sexmatched controls. Lifestyle factors were assessed via a face-to-face structured interview. The association between achalasia and lifestyle factors was assessed by unconditional logistic regression, to produce odds ratios(OR) and 95% confidence interval(CI).RESULTS: Individuals who had low-class occupations were at the highest risk of achalasia(OR = 1.88, 95%CI: 1.02-3.45), inferring that high-class occupation holders have a reduced risk of achalasia. A history of foreign travel, a lifestyle factor linked to upper socioeconomic class, was also associated with a reduced risk of achalasia(OR = 0.59, 95%CI: 0.35-0.99). Smoking and alcohol consumption carried significantly reduced risks of achalasia, even after adjustment for socio-economic status. The presence of pets in the house was associated with a two-fold increased risk of achalasia(OR = 2.00, 95%CI: 1.17-3.42). Nochildhood household factors were associated with achalasia risk.CONCLUSION: Achalasia is a disease of inequality, and individuals from low socio-economic backgrounds are at highest risk. This does not appear to be due to corresponding alcohol and smoking behaviours. An observed positive association between pet ownership and achalasia risk suggests an interaction between endotoxin and viral infection exposure in achalasia aetiology.

Bayesian methods in reporting and managing Australian clinical indicators

Sustained clinical improvement is unlikely without appropriate measuring and reporting techniques. Clinical indicators are tools to help assess whether a standard of care is being met. They are used to evaluate the potential to improve the care provided by healthcare organisations(HCOs). The analysis and reporting of these indicators for the Australian Council on Healthcare Standards have used a methodology which estimates, for each of the 338 clinical indicators, the gains in the system that would result from shifting the mean proportion to the 20 th centile. The results are used to provide a relative measure to help prioritise quality improvement activity within clinical areas, rather than simply focus on "poorer performing" HCOs. The method draws attention to clinical areas exhibiting larger between-HCO variation and affecting larger numbers of patients. HCOs report data in six-month periods, resulting in estimated clinical indicator proportions which may be affected by small samples and sampling variation. Failing to address such issues would result in HCOs exhibiting extremely small and large estimated proportions and inflated estimates of the potential gains in the system. This paper describes the 20 th centile method of calculating potential gains for the healthcare system by using Bayesian hierarchical models and shrinkage estimators to correct for the effects of sampling variation, and provides an example case in Emergency Medicine as well as example expert commentary from colleges based upon the reports. The application of these Bayesian methods enables all collated data to be used, irrespective of an HCO's size, and facilitates more realistic estimates of potential system gains.

Ovarian cancer in Kenyatta National Hospital in Kenya: Characteristics and management

Background: Ovarian cancer is the third commonest cause of cancer death from gynaecologic tumors in Kenya. Early disease causes minimal, nonspecific, or no symptoms therefore, most patients are diagnosed when the disease is at an advanced stage. Overall, prognosis for these patients remains poor but has not been described in Kenya. Objectives: To describe the histological types, therapeutic methods used, therapeutic outcome and the survival rate at 2 years. Methods: This was a retrospective cross-sectional descriptive study undertaking a 10-year review of case records of patients treated for cancer of the ovary between 1998 and 2008 in Kenyatta National Hospital. Results: Majority of the patients (73.3%) presented with advanced stage of disease (stages III & IV). Epithelial tumors (86.2%) are the commonest histological type, with 45.7% of them being serous type. Chemotherapy was the most (46.0%) used therapeutic option, with vomiting and diarrhea being the leading morbidity associated with it. Survival at 2 yrs from diagnosis was 50% as per the Kaplan-Meier time survival estimate. Conclusion: There is need to improve the quality of data on cancer care and information systems in general to provide a reliable source of information to guide research and policy in oncology. Further, the late presentation to hospital calls for innovative strategies to improve ovarian cancer awareness and uptake of screening tests. There is need to lobby Governments in resource limited setting to subsidize cancer of the ovary care and invest in lower level health facilities to promote early diagnosis and decongest the referral hospital.

Inhaler Technique Questionnaire(InTeQ)in pediatric patients with asthma

Asthma in school-aged children is a major public health problem worldwide[1,2].Inhaled medications are the mainstay of its pharmacological management[2],but only 8%-22%of children with asthma use their inhalers correctly[3].Asthma clinical outcomes are poor in children[4],largely due to inhaler technique[5,6].