Health Charts Research Articles

Chikungunya: important lessons from the Jamaican experience

ABSTRACTObjectives.To describe the clinical presentation of chikungunya virus (CHIKV) illness in adults during the 2014 outbreak in Jamaica and to determine the predictive value of the case definition.Methods.A cross-sectional study was conducted using clinical data from suspected cases of CHIKV that were reported to the Ministry of Health in April – December 2014. In addition, charts were reviewed of all individuals over 15 years of age with suspected CHIKV based on a diagnosis of CHIKV or “acute viral illness” that presented to four major health centers in Jamaica during the week prior to and the peak week of the epidemic. Data abstracted from these charts using a modified CHIKV Case Investigation Form included demographics, clinical findings, and laboratory tests.Results.In 2014, the Ministry of Health of Jamaica received 4 447 notifications of CHIKV infection. PCR testing was conducted on 137 suspected CHIKV cases (56 men and 81 women; median age 28 years) and was positive for 89 (65%) persons. In all, 205 health charts were identified that met the selection criteria (51 men and 154 women, median age 43 years). The most commonly reported symptoms were arthralgia (86%) and fever (76%). Of those who met the epidemiologic case definition for CHIKV as defined by the Pan American Health Organization, only 34% had this diagnosis recorded. Acute viral illness was the most frequently recorded diagnosis (n = 79; 58%).Conclusions.Broader case definitions for acute CHIKV illness may be needed to identify suspected cases during an outbreak. Standardized data collection forms and validation of case definitions may be useful for future outbreaks.

Growth charts for Brazilian children with Down syndrome: Birth to 20 years of age.

BackgroundThe growth of youth with Down syndrome (DS) differs from that of youth without DS, and growth charts specific to DS have been developed. However, little is known about the growth of Brazilian youth with DS. The objective of this study was to construct growth charts for Brazilian youth with DS and compare the growth data with the Child Growth Standards of the World Health Organization (WHO) and charts for children with DS from other studies.MethodsMixed longitudinal and cross-sectional data were collected at University of Campinas, 48 specialized centers for people with intellectual disabilities, and two foundations for people with DS between 2012 and 2015. A total of 10,516 growth measurements from birth to 20 years of age were available from 938 youth with DS (53.7% boys) born between 1980 and 2013. The Lambda Mu Sigma method was applied to construct the curves using generalized additive models for location, scale, and shape.ResultsLength/height-for-age, weight-for-age, and head circumference-for-age percentile curves were generated for Brazilian boys and girls from birth to 20 years of age. Differences in growth of Brazilian youth ranged from −0.8 to −3.2 z-scores compared to WHO standards, and −1.9 to +1.3 compared to children with DS in other studies.ConclusionsThese specific growth charts may guide clinicians and families in monitoring the growth of Brazilian children and adolescents with DS.

Rapid Weight Gain in Pediatric Refugees after US Immigration.

Prior studies of immigrants to the United States show significant weight gain after 10years of US residence. Pediatric refugees are a vulnerable population whose post-immigration weight trajectory has not been studied. We examined the longitudinal weight trajectory of 1067 pediatric refugees seen in a single university based refugee health program between the dates of September 3, 2012 and September 3, 2014 to determine how quickly significant weight gain occurs post-arrival. The most recent BMI was abstracted from the electronic health record and charts reviewed to obtain serial BMI measurements in 3year increments after the date of US arrival. The mean arrival BMI percentile for all refugees was 47th percentile. This increased significantly to the 63rd percentile within 3years of US arrival (p<0.01). This rapid increase was largely attributable to African and South and Southeast Asian refugees. The overall prevalence of age and sex adjusted obesity rose from 7.4% at arrival to 18.3% within 9years of US immigration exceeding the pediatric US national obesity prevalence of 16.9%. Pediatric refugees are at increased risk of rapid weight gain after US immigration. Targeted interventions focused on prevention of weight gain in specific populations are warranted.

Implementing a Policy and Protocol on Managing Patients With Hypertensive Urgencies.

The use of short-acting agents, such as clonidine, for hypertensive urgency has been shown to worsen outcomes and, therefore, should be avoided in the office. The primary objective was to achieve decreased rates of clonidine orders for immediate treatment of asymptomatic hypertension in the office. The secondary objective was to determine if reduced use leads to a decline in poor outcomes. This was an observational cohort study evaluating a protocol and algorithm developed by clinical pharmacists on the appropriate management of hypertensive urgencies. The protocol included the provision of avoiding short-acting antihypertensives (ie, clonidine). Preintervention and postintervention reports were generated to determine the number of times clonidine was ordered in the office. Electronic health charts were also reviewed for documentation of poor outcomes related to clonidine administration within 1 week of the hypertensive urgency visit date. In the preintervention cohort, 106 (17.4%) orders of clonidine were captured compared with 73 (10.6%) in the postintervention group (P = 0.001). Of the patients who were administered clonidine, 7 patients in the preintervention group were advised to go to the emergency department (ED) for additional hypertensive management, 2 of whom were subsequently hospitalized; 9 patients were advised to go to the ED in the postintervention group, and no patient was subsequently hospitalized. No adverse effects were documented from in-office clonidine administration in either cohort of patients. The hypertensive urgency protocol and education reduced the number of clonidine orders and hospital admissions. The increase in ED referrals needs further assessment.

Celiac Disease Alone and Associated With Type 1 Diabetes Mellitus.

The aim of the study was to evaluate complication screening and follow-up patterns in a population with type 1 diabetes mellitus and celiac disease (T1D/CD) in relation to a matched cohort with celiac disease (CD) alone at our center. We retrospectively reviewed the health charts of 41 children with T1D and biopsy-proven CD and compared anthropometrics and complication of screening within 2 years from CD diagnosis. Follow-up patterns were determined 3 years postdiagnosis. This population was then compared with a population with both symptomatic and asymptomatic CD matched for age and sex. In comparison with T1D/CD, patients with CD alone had a significantly lower height, weight and body mass index (BMI z score 0.01 vs 0.81, P = 0.001) and higher rates of screening for anemia (95% vs 71%, P = 0.003) and bone health (49% vs 29%, P = 0.05). Minimal rates of laboratory abnormalities were observed in either group, irrespective of symptoms at presentation, but CD alone more often presented with anemia than T1D/CD. Repeat serology testing was significantly more frequently performed in the T1D/CD group. Follow-up was equally variable with a median of 3 (range 0-4) visits with a gastroenterologist during the first 3 years postdiagnosis. These results suggest that patients with T1D/CD represent a distinct and possibly milder phenotype from CD alone. Complication screening was variable and negative for the majority of the patients. Guidelines for follow-up may need to be tailored to specific groups to standardize evaluation and complication screening, especially with regard to bone health.

Neonatal cleft lip repair in babies with breastfeeding difficulties at Polokwane Mankweng Hospital Complex

Background. A cleft lip (CL) is a congenital abnormality resulting from failure of union of the medial and nasal prominences with the maxillary prominence during embryonic development. CL may be classified as incomplete, complete, unilateral, bilateral or median. It may be associated with a cleft alveolus or a cleft palate. Definitive correction of a cleft lip is by surgery. In most African settings, the birth of a cleft lip and cleft palate (CLP) baby is associated with witchcraft and ancestral spirits. The parents, particularly mothers, are stigmatised. Objective. To repair CLs in neonates with difficulties in breastfeeding. Methods. Non-syndromic term neonates referred to Polokwane Mankweng Hospital Complex (PMHC) from primary and secondary hospitals with CLP and difficulties in breastfeeding were prospectively admitted to the neonatal unit. Our breastfeeding team supervised and assisted them with breastfeeding. The neonates whose breastfeeding was found to be unsatisfactory were considered for neonatal CL repair.Those who breastfed adequately were booked for later lip repair as per the rule of tens and discharged. Results. From June 2009 to March 2012, 60 children with CLP were referred to PMHC, including 36 neonates. Of these, 23 neonates were unable to breastfeed satisfactorily and were operated at a median age of 9 (range 3 - 28) days. The median weight was 2.8 (1.8 - 3.7) kg. The median haemoglobin was 13.1 (11.5 - 16) g/dL. Conclusion. Neonatal CL repair is an alternative for those with breastfeeding difficulties. Eagerness to breastfeed increased following the lip repair with subsequent improvement in maternal confidence and interaction with the baby. At follow up, weight gain was above the 50th centile on the road to health charts. Early surgery prevents exposure of CL to the public with highly positive possible outcome of decreasing the potential for stigmatisation.

The Connected Age: Digital Tools for Health

my September/October column in Nursing Education Perspectives, I wrote about Connected Age and Wearable Technologies (Skiba, 2014). this column, I will continue the conversation and discuss a real game changer - patient-generated health data (PGF1D) - that is certain to affect how we deliver care while also placing the patient/consumer front and center.The story begins with Apple. This past September, Apple intro- duced its new iPhone 6 and iPhone 6 Plus, with the new operating system OS 8, which contains a health dashboard. These smartphones had 3 million pre-orders. Earlier in the year, Apple created a FlealthKit for third-party developers. And soon to be available, in 2015, is Apple's long-awaited entry into the wearable market, the Apple Watch.Is the convergence of these three Apple components a game changer in terms of consumers and health care? Let's look at their individual contributions to the health care marketplace.THE TROIKAOS 8 Operating System Health AppThe OS 8 operating system Flealth App, signified with a white back- ground and a red heart, allows you to create a medical ID and enter health data such as physical activity, nutrition, and vital signs. The app can monitor your physical activity using iPhone motion sensors; data are displayed on an easy-to-read dashboard that allows you to select a particular measure and graph it by day, week, month, or year.Duffy (2014), writing in PC Magazine, outlines how you can set up your medical ID and emergency contact information. Next, she explains how you can use numerous third-party apps for automatically importing data. Once you have your data entered, you can create cards or health charts that can be placed on your dashboard, using these to monitor your health, show your health care provider, and, in some cases, connect to a hospital or clinic electronic health record (EFTR).You can see how easily one can become an engaged patient using a smartphone. Flail (2014) provides a running list of health apps avail- able for the OS 8 operating system, including blood pressure monitors, activity trackers, weight scales, and sleep trackers.HealthKitApple created the FlealthKit platform so that third-party developers could design apps that provide data to various providers and organi- zations. Many electronic health record companies are also planning to interconnect their systems and allow the addition of patient-generated health data. The FlealthKit platform allows PGF1D as well as sensored data from various devices. Gregg (2014b) describes five apps that inte- grate with the FlealthKit, including the following:* American Well allows patients in a telemedicine video visit to share patient-generated data. Its CEO states: For the first time, we can make a connection between consumer health data on your iPhone and a doctor that visits your home over video. This opens a world of opportunity, with increased access to care for people everywhere and better care of patients with chronic conditions.* Humana allows consumers to share their health data, steps in particular, with their product Vitality and earn points to reward their progress. Vitality then translates those points into rewards such as movie tickets and music downloads.* Patient IO uses PGHD from the HealthKit platform to update the personalized treatment plans it creates.Health care organizations and EHR corporations, such as Cerner and Epic, will be integrating with HealthKit. Cerner (Gregg, 2014c) will be integrating key health metrics into its mobile platform. Cerner Wellness, to share with health coaches to provide incentives and other new opportunities. Stanford University Hospital (Selleck, 2014) will start a trial using HealthKit with children with Type I diabetes. The plan is to give patients an iPod Touch to track blood sugar levels using DexCom, which will integrate its glucose sensors with HealthKit for storing the data. …

Timely HIV Diagnosis and HIV/TB Comanagement among California Patients in 2008

National guidelines highlight the roles of early HIV diagnosis and effective comanagement for HIV and tuberculosis (TB) to prevent mortality and morbidity from HIV-related TB. We assessed HIV diagnosis timing and HIV/TB comanagement for California HIV/TB patients. We reviewed and analyzed public health charts for California HIV/TB patients reported during 2008. HIV diagnoses fewer than three months before TB diagnosis were considered new HIV diagnoses. We determined the proportion of patients with new HIV diagnoses, risk factors for new HIV diagnoses, and proportion of patients receiving recommended CD4 cell count measurements, supervised TB therapy, and antiretroviral therapy (ART). Of 130 HIV/TB patients, 51% had new HIV diagnoses. Foreign-born patients were more likely than U.S.-born patients to have new HIV diagnoses. Supervised TB therapy and CD4 cell count measurements followed national recommendations for 91% and 74% of patients, respectively. At least 73% of patients started ART before completing TB therapy. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses started ART later and had lower CD4 cell counts and higher viral loads at TB diagnosis. Although most HIV/TB patients received the recommended treatment, half had new HIV diagnoses. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses had greater immunosuppression at TB diagnosis. A new diagnosis indicates that HIV could have been diagnosed earlier and ART or treatment for latent TB infection could have been initiated to prevent TB development.

Play to the Whistle: A Pilot Investigation of a Sports-Based Intervention for Traumatized Girls in Residential Treatment

Adolescents in residential treatment settings have symptoms that prevent them from participation in normal youth activities, which in turn prevent development of social skills and competencies. A sports-based intervention called “Do the Good” (DtG) was designed for this population using trauma-informed treatment principles. This paper describes the intervention model and presents outcome data. A total of 88 female residential students aged 12 to 21 participated, including 62 students voluntarily enrolled in the sports league and 26 treatment-as-usual (TAU) comparisons. Positive behaviors (e.g., helping peers, perseverance) during games were observed and coded for sports league participants and their coaches. Mental health charts of DtG and TAU participants were reviewed for behavior and symptoms prior to program participation, and again post-program. Girls in the sports league exhibited reductions in restraints and time-outs, as well as internalizing and externalizing symptoms. These data provide evidence that sports-based interventions present a promising adjunctive approach for traumatized youth.

Low Heart Rates Predict Incident Atrial Fibrillation in Healthy Middle-Aged Men

Low resting heart rate (HR) has been associated with atrial fibrillation (AF) in athletes. We aimed to study whether low HR at rest or during exercise testing was a predictor of AF in initially healthy middle-aged men. A total of 2014 healthy Norwegian men participated in a prospective cardiovascular survey, including a standardized bicycle exercise test in 1972 to 1975. During ≤35 years of follow-up (53,000 person-years of observation), 270 men developed incident AF, documented by scrutiny of health charts in all Norwegian hospitals. Risk estimation was analyzed with Cox proportional hazard models. Low exercise HR after 6 minutes exercise on the moderate workload of 100 W (HR100W) was a predictor of incident AF. Men with HR100W <100 beats per minute (n=260) were characterized by high physical fitness, low resting and low maximum HR, and they had 1.60-fold AF risk (95% confidence interval, 1.11-2.26) compared with men with HR100W ≥100 beats per minute when adjusted for age, systolic blood pressure, and physical fitness. Additional adjustment for relative heart volume slightly reduced the association. The subgroup of men (n=860) with hypertensive blood pressure measurements at baseline had the highest risk difference between low and high HR100W with hazard ratio 2.08 (1.19-3.45). Our data indicate that low exercise HR on a moderate workload is a long-term predictor of incident AF in healthy middle-aged men. Elevated baseline blood pressure substantially amplifies this risk. The present results suggest a relationship between increased vagal tone, high stroke volumes and incident AF, and particularly so in physically fit men.

Making strides in women's mental health care delivery in rural Ethiopia: demographics of a female outpatient psychiatric cohort at Jimma University Specialized Hospital (2006-2008).

This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women’s mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services.

HIV Status Determination Among Tuberculosis Patients From California During 2008

Human immunodeficiency virus (HIV) infection complicates care and contributes to poor outcomes among tuberculosis (TB) patients. The Centers for Disease Control and Prevention recommends that providers test all TB patients for HIV. We assessed completeness of HIV status determination among TB patients and identified key gaps in adherence. We conducted a retrospective review of public health charts to determine the HIV status for all TB patients reported in California during 2008. We then used logistic regression to determine the factors associated with a known (positive or negative) HIV status. A random sample of TB patients was selected for secondary review to characterize the timing of HIV status determination and the providers who had opportunity to test for HIV. California TB programs. All TB patients reported from California in 2008. Proportion of patients with a known HIV status, adjusted odds ratios for having a known HIV status, proportion of patients with a known HIV status before TB diagnosis, and proportion of patients diagnosed with TB by different provider types. Only 1752 (66%) of 2667 TB patients had a known HIV status. Having a known HIV status was strongly associated with those aged between 15 and 44 years and being managed with any public provider involvement. Of 292 patients in the random sample, 12 patients (4%) had a known HIV status before TB diagnosis. Among the remaining 280 patients, 187 patients (67%) were diagnosed with TB by a private provider. The HIV status determination of TB patients was selective and not routine as recommended. Private providers can play a key role in testing for HIV at TB diagnosis. California TB programs should ensure that all TB patients have an HIV status by promulgating national recommendations, educating private providers on the benefits of testing TB patients for HIV, and monitoring completeness of HIV status determination.

Utilization of CHC (Complete Health Checkup) Type Charts to Improve the Students’ Understanding of Clinical Pathology

Second year undergraduate medical students lack an integrated approach towards the basic laboratory data. So, they find it difficult when analytical exercises are asked for in pathology practical examinations. A Complete Health Checkup (CHC) is one exercise where an individual undergoes a clinical examination, followed by various basic laboratory tests, along with other tests like ECG, X-ray and USG of the abdomen. A critical analysis of such charts would help in developing higher cognitive skills in the form of integration of all the data which is available, in order to arrive at a final diagnosis. We hypothesized that facilitating the students to analyze a set of clinical pathology tests by using CHC charts as modules would enhance their integrated approach towards the laboratory data. To evaluate the use of pre designed complete health charts which were designed to enhance the students' ability to apply and integrate their knowledge on the clinical pathology data. Two batches of 44 students each (Group 1 and Group 2), who attended the clinical pathology postings, were included in the study (totally 88 students). Informed consents were obtained from all of them. In addition to their routine posting schedules, the students in Group 2 were exposed to fifteen CHC charts, one at a time, with the subsequent analysis of each chart by using an objective test and a discussion. At the end of their clinical pathology postings, an OSPE was conducted for all the students and the test scores were analyzed. The statistical analysis was done using SPSS, version 15. Group 1 obtained a score which ranged from 48% to 78%, with a mean±SE (mean) of 62.0% ± 1.21 and Group 2 obtained a score which ranged from 65% to 94%, with a mean±SE (mean) of 86.2% ± 0.96. The Student's-t-test for the equality of means with a value of 15.59 (p=0.000), implied a statistical significance in the mean score, as was observed between the two groups. Facilitating the students' learning by using CHC charts helps in improving the students' capacity to analyze and interpret the clinical pathology data and so, it can be utilized on a routine basis.

Use and quality of mental health services for Haitian youth

Objective. To describe the mental health service use of Haitian, African-American, and non-Latino White youth in a community mental health setting. Groups are compared on adherence to treatment guidelines for attention-deficit/hyperactivity disorder (ADHD) and depressive disorders. Design. Retrospective review of outpatient mental health charts (n=252) from five community sites in an urban area of the Northeastern United States. We recorded the total number and treatment type of sessions during the first six months of treatment. Guideline-adherent treatments were compared and predicted after controlling for clinical need. Results. Most Haitian and African-American youth stopped treatment by six months, with the majority attending less than eight sessions. One third of Haitian and African-American patients attended just one session. Haitian patients who presented with less severe symptoms and dysfunction were more likely to have single-session treatments. Guideline-adherent treatment for ADHD and depression was less likely for Haitians. Older patients were more likely to receive adequate depression treatment. Haitian youth were relatively underinsured, had more family separations documented, and received Adjustment Disorder diagnoses more often. Conclusions. Haitian youth use outpatient mental health services in similar proportion to African-American youth and at lower rates than White youth. Guideline-adherent treatment for ADHD and depression is limited by low retention in care for Black youth. Low insurance coverage is likely an important contributor to reduced use of services, especially for Haitians. These findings are discussed in the context of providing culturally sensitive mental health care to diverse communities.

Does Allocation of Low Risk Parturient Women to a Separate Maternity Unit Decrease the Risk of Emergency Cesarean Section?

In response to escalating rates of cesarean section, the Norwegian Parliament in 2001 decreed that maternity units should be organized into separate units to differentiate between low and high risk deliveries. This action was based on the assumption that low risk patients were being subjected to unnecessary and possibly harmful interventions when treated together with high risk patients. Moreover, it was suggested that the calmer environment for low risk women and less need for medical interventions would achieve a better outcome for mother and child. Accordingly, a number of obstetrical departments were reorganized by physical separation of perceived high and low risk patients. However, the benefit of separate maternity units for low risk patients is questionable. A Cochrane review reported that births in home-like settings appeared to have only a marginally lower rate of cesarean births. No studies have examined the effect of separating low and high risk pregnancies on frequency of cesarean deliveries. This hospital-based registry study investigated whether assignment of women with low risk births to special maternity units reduced emergency cesarean section rates compared with giving birth in a unit with mixed cases. The patient population was comprised of women with intended vaginal delivery during 2001-2003 at 2 urban university hospitals in Norway. There were a total of 11,686 low and high risk deliveries. Data were obtained from standardized prenatal and perinatal health charts. The primary study outcome measure was the risk of emergency cesarean section. The risk of emergency cesarean section was higher in the low risk maternity unit compared with a maternity unit with both high and low risk women; the adjusted odds ratio was 1.4, with a 95% confidence interval of 1.2 to 1.6. These findings provide no support for the separation of maternity wards into high and low risk units. Lower rates of emergency cesarean section among the mixed cases may be due to the better maternity care of low risk women by personnel who are trained to manage high risk pregnancies.

Reliability and Validity of COOP/WONCA Functional Health Status Charts for Stroke Patients in Primary Care

Dartmouth Coop Functional Health Assessment/World Organization of National Colleges, Academies and Academic Association of General Practitioners (COOP/WONCA) functional health assessment charts depict levels of function/well being along 5-point ordinal scales in 6 domains. Responses, illustrated by drawings, make these charts a suitable tool for the stroke population, given the high prevalence (20%) of language impairment in this population. This study examined the validity and reliability of COOP/WONCA charts for community-dwelling stroke survivors. A total of 55 participants in this cross-sectional study completed COOP/WONCA Charts, Hospital Anxiety and Depression Scale (HAD), Stroke Specific Quality of Life Scale (SSQoL), EuroQoL EQ-5D and visual analogue scale (VAS), International Physical Activity Questionnaire (IPAQ), and Astrand-Rhyming submaximal oxygen volume (VO₂) fitness test. Spearman's correlation coefficient was used to test criterion validity, Cronbach's α was used to test internal validity, and the Mann-Whitney U tested discriminative validity. A subgroup (n = 30) completed COOP/WONCA charts 2 days later, and test-retest reliability (Kendall's τ-b statistic) analysis was conducted. Good agreement was observed between COOP/WONCA physical fitness chart, VO₂, and IPAQ (ρ = -0.438, P = .001; ρ = -0.497, P < .001), COOP/WONCA feelings chart and HAD anxiety and depression scores (ρ = 0.498, P < .001; ρ = 0.494, P < .001), COOP/WONCA overall health chart and EuroQol EQ-5D VAS (ρ = -0.535; P < .001), and COOP/WONCA daily activity and social activity charts and SSQoL (ρ = -0.371, P = .005; ρ = -0.463, P < .001). Cronbach's α (0.72) reflected good internal consistency among COOP/WONCA scales. Discriminative ability for independent ambulation and clinical depression was demonstrated (U = 103.5, P < .001; U = 156, P = .015). Test-retest reliability in each domain except Changes in Health was significant at P < .05 (Kendall's τ-b, 0.344-0.653). Our data indicate that the COOP/WONCA Functional Health charts demonstrate good validity and overall reliability for use with stroke patients in primary care.

108 The Use of Wet-to-Dry Wound Dressings

Purpose: The purpose of this study was to determine the current use of wet-to-dry dressings as the principal wound care modality ordered by health care providers. In addition, this study describes the types of wounds wet-to-dry dressings are currently used for, the specialty of health care providers most likely to order these dressings, and associated data that indicates whether or not the clinical condition of the wound warrants the use of wet-to-dry dressing for mechanical debridement. Method: This descriptive study involved a retrospective chart review of 202 home health and HMO case managed patients with open wounds One hundred and two HMO charts were reviewed; only 74 had sufficient data documented. One hundred and sixty-one home health charts were reviewed; only 128 were appropriate for data collection (closed incisions, drainage tubes, ostomies, and those charts where more than six items on the data collection sheet were not documented in the chart, were not used). The data was analyzed using SPSS. Findings: This study suggests that the current use of wet-to-dry dressings is over 41% of all principal wound care modalities, followed by enzymatic (7.43%) and dry gauze (6.93%). The majority of wet-to-dry dressings ordered are for surgical wounds (69%), followed by neuropathic ulcers (10%) and pressure ulcers (5.9%). Furthermore, this study suggests that general surgeons are most likely to order wet-to-dry dressings (38%). Data also indicated that in over 78.6% of wounds treated with wet-to-dry dressings, mechanical debridement was not indicated (the percent of granulating tissue in the wound bed was > 75%). In only 3.5% of wounds treated with wet-to-dry dressings was mechanical debridement possibly indicated by the amount of nonviable tissue in the wound bed. Discussion: Clinicians need to be involved in research that will lead to evidenced based clinical practice and standardized wound care. The scientific literature suggests that wet-to-dry dressings are not evidenced based, but are detrimental to the granulating wound bed, painful, costly, and one of the least effective methods of debridement available today.

Sociodemographic background, lifestyle and psychosocial conditions of Swedish teenage mothers and their perception of health and social support during pregnancy and childbirth

Among Swedish pregnant teenage girls it is unusual to continue pregnancy and to choose to have a baby. Swedish teenage mothers can therefore be expected to differ from adult mothers, at a group level. The aim of this study was to describe and compare teenage mothers who were giving birth in hospital with adult mothers as to sociodemographic background, perception of health and social support. A descriptive comparative study was conducted over one year, in a county in south-western Sweden, which comprised a group of all teenage mothers aged 15-19, who gave birth at hospital (study group n=97) and the same number of adult mothers aged 25-29, matched for parity and birth of a baby closest to the index mother (reference group). Both groups answered a questionnaire regarding sociodemographic variables, lifestyle, health, self-esteem, depressive symptoms, and support. Information on the mothers' pregnancy and delivery was obtained from their maternal health and delivery charts. Teenage mothers had more often been exposed to a difficult family situation, had more often experienced school failure than adult mothers, and showed health-risk behavior. Teenage mothers perceived less support, had lower self-esteem, and more depressive symptoms than adult mothers. Teenage mothers differed from adult mothers regarding family situation and health behavior as well as perception of support, self-esteem, and depressive symptoms, which may negatively influence their ability to cope with parenthood. Efforts should be made early in pregnancy to meet both health and support needs of teenage mothers.

Prevalencia de enfermedad renal crónica en los hipertensos seguidos en los centros de salud de España y grado de control de su presión arterial (estudio DISEHTAE)

To establish what proportion of hypertensive patients being treated in the primary care health centres of Spain have diminished renal function, and to ascertain their level of blood pressure (BP) control. Descriptive, cross-sectional study, based on an external audit of clinical charts. Primary care health centres in 14 autonomous regions. A total of 6,113 charts of hypertensive patients from 107 primary care health centres were checked. The selection of primary care health centres and charts was randomized. Creatinine and BP figures of the patients included were analyzed. Chronic kidney disease was defined as a glomerular filtration rate (GFR), as calculated by the equation developed by the Modification of Diet in Renal Disease (MDRD) Study, at under 60 mL/min per 1.73 m(2) of body surface area. A good level of BP control was defined as having figures lower than 130/80 mm Hg. Of all patients, 25.7% (95% CI, 24.3-27.2) had a diminished GFR. Of these, 19.1% (95% CI, 16.6-21.9) had a good level of control of systolic BP, 49.9% (95% CI, 46.6-53.2) had a good level of control of diastolic BP, and 15.2% (95% CI, 12.9-17.8) had a good level of control of both. A considerable proportion of hypertensive patients under treatment in the primary care health centres of Spain have a diminished GFR. Only 1 in 6 of these have their BP under control.

Registros em saúde: avaliação da qualidade do prontuário do paciente na atenção básica, Rio de Janeiro, Brasil

With the purpose of contributing to the evaluation of primary care, a study was conducted based on the quality of patients' health charts, considering the records for care provided in 4 municipalities with more than 100 thousand inhabitants each in the State of Rio de Janeiro, Brazil, in 2004. This was a cross-sectional study based on primary data collected from direct consultation of patient charts. A two-stage, probabilistic cluster sample was selected from primary care facilities and consultations/patient charts. We checked the completeness of attributes pertaining to the identification of users receiving care and the characteristics of the care itself (weight, blood pressure, Pap tests, and blood glucose) on the charts of women over 19 years of age with hypertension and/or diabetes. User identification showed a low presence of social attributes, and only half of the charts had recorded the opening date. Records of process characteristics in care provided to women with hypertension and diabetes failed to conform to Brazilian Ministry of Health guidelines. Analysis of completeness suggests dubious quality in the continuity of the care provided and difficulties in management practice for primary care and implementation of the Family Health Strategy.