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AbstractWe examined the association between multidrug resistance and socioeconomic status (SES), analyzing microbiological and ZIP-code–level socioeconomic data. Using generalized linear models, we determined that multidrug resistance is significantly and persistently more prevalent in samples taken from patients residing in low-income ZIP codes versus high-income ZIP codes in North Carolina.

The professionalization of the fields of health education and health promotion has largely coincided with the completion of job task analysis conducted by major organizations in the field (e.g., the National Commission for Health Education Credentialing, Society for Public Health Education). The process through which these job task analyses and skill-based competencies are implemented in professional preparation programs poses a risk to stifle advancement and innovation in health education and promotion. In this perspective, we discuss Competency Focused Practice (the current state of the field) to a goal of Philosophically Grounded Practice. We provide comparisons of the implications of these two schools of thought with respect to ethics, social determinants of health, and practical methods in health education and promotion.

Anyone who has seen Finnish accordion dynamo Kimmo Pohjonen perform will never forget it. On stage, he's uninhibited, even unhinged. His athletic energy takes over the stage like a feral [...]

This article describes the integration of medical anthropologists as direct members of health care teams within a large, urban teaching hospital as a means to address the role of structural inequality in unequal health care delivery within the context of COVID-19. The pandemic starkly underlined the role structural forces such as food insecurity, housing instability, and unequal access to health insurance play among vulnerable populations that seek health care, particularly within the emergency department (ED). There is a critical need to recognize the reality that disease acquisition is a cultural process. This is a significant limitation of the biomedical model, which often considers disease as a separate entity from the social contexts in which disease is found. Further, a focus on patient-centered care can open the door for critical, clinically applied, medical anthropologists to team with physicians, merging ethnographic methods with health data and the socially constructed realities of patients’ lived experience to build new pathways of care. These pathways may better prepare physicians and health care systems to respond to novel threats like COVID-19, which are rooted in pathophysiological origins but have outcome distributions driven by cultural and structural determinants. To this end, we propose a reconfiguration of dominant biomedical ideologies around disease acquisition and spread by examining our work since 2018, which sees anthropologists embedded both locally and systematically in the creation of anthropologically informed treatment pathways for socially complex disease states like HIV, Hepatitis C, and Opioid Use Disorder (Henderson 2018). Understanding how these socially complex diseases concentrate and interact in populations is a potential opportunity to model solutions for other widespread and complex health care crises, including COVID-19.

My son is two weeks old. I am sitting on the couch, nursing him. Warmly enveloped, he seems to be enjoying the full sensuality of the experience. I stroke him, […]

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Byline: Heather Henderson, CSEP, CMP Having recently returned from the highly successful and energizing events at ISES Eventworld 2011 in St. Louis, I am excited about the organization's future and [...]

Children with single–right ventricle anomalies such as hypoplastic left heart syndrome (HLHS) have left ventricles of variable size and function. The impact of the left ventricle on the performance of the right ventricle and on survival remains unclear. The aim of this study was to identify whether left ventricular (LV) size and function influence right ventricular (RV) function and clinical outcome after staged palliation for single–right ventricle anomalies.

We sought to evaluate the prevalence of delayed puberty and abnormal anthropometry and its association with quality of life (QoL) in young Fontan survivors. This was a cross‐sectional study at 11 Pediatric Heart Network centers. Demographic and clinical data, anthropomety, and Tanner stage were collected. Anthropometric measurements and pubertal stage were compared to US norms. QoL was assessed using Pediatric Quality of Life inventory (PedsQL). Mixed effects regression modeling adjusting for clustering by center was used to evaluate factors associated with abnormal anthropometry and delayed puberty and associations with QoL. Of the 299 subjects, 42% were female. The median enrollment age was 13.9 years, and the median age at Fontan was 3 years. Fontan survivors had a higher prevalence of short stature relative to normative data (20% vs 5%, P< .0001) and an increased prevalence of abnormal BMI (16% vs 10%, P< .0001) (low [43%] and high [57%]). Fontan subjects, both males (58%) and females (58%), had a delay of 1.5‒2 years in ≥1 Tanner stage parameter compared to normal population. There was no association between delayed puberty and QoL. Abnormal anthropometry was associated with lower overall (62.3 ± 17.3 vs 72.5 ± 16.6; P< .001) and physical appearance scores (72.2 ± 27.4 vs 79.8 ± 21.5; P< .01). Lower exercise capacity was associated with abnormal anthropometry and >2 surgeries before Fontan was associated with delayed puberty. Lower family income (<$25 000) and hypoplastic left heart syndrome were associated with lower QoL. Compared to the normal population, Fontan survivors have high prevalence of short stature, abnormal BMI and delayed puberty. Abnormal anthropometry, but not delayed puberty, was associated with lower overall QoL and perceived physical appearance scores. Routine screening for abnormal anthropometry, especially in HLHS and in lower socioeconomic status families, should be considered to allow interventions, which might ameliorate the negative psychosocial impact.

SIR: I thought John Stone's assessment of the Howard prime minister-ship (March 2008) outstanding--insightful, judicious, and balanced. It should remain definitive. John Carroll (Professor of Sociology), La Trobe University, Bundoora, [...]

Background:The Pulmonary Artery Pulsatility index (PAPi) is calculated by pulmonary artery pulse pressure divided by central venous pressure and is directly proportional to right ventricular contractility and stroke volume, and indirectly proportional to pulmonary artery afterload and filling pressures. We hypothesize that PAPi will correlate with known hemodynamic parameters and predict acute kidney injury (AKI) post heart transplant (HTx).Methods:Medical records and hemodynamic data were retrospectively reviewed for patients ≤18 years old undergoing HTx at a single center between 1/2007-9/2021. Subgroups by HTx indication were myopathy or congenital heart disease (CHD). PAPi was calculated at catheterizations up to 5 years post HTx, with normal ≥ 2.0.Results:Fifty-three children underwent HTx in myopathy (n=27) or CHD (n=26) subgroups. Mean age at HTx was 5.95 ± 6.13 years (range: 58 days-18 years) with no difference between myopathy and CHD subgroups. PAPi correlated with known cardiovascular measures including thermodilution cardiac index (TDCI) and right ventricular end-diastolic pressure (RVEDp), confirming PAPi as a predictor of cardiovascular hemodynamics (Table 1).At 1 year, children with AKI (n=11/49) had a lower PAPi compared to those with no AKI (1.55 ± 0.43 vs. 2.50 ± 1.16; p=0.004). Comparing initial to 5-year PAPi, the myopathy subgroup (n=18) remained similar (2.10 ± 0.99 vs. 2.12 ± 1.55; p=0.48) and the CHD subgroup (n=12) declined significantly (2.12 ± 0.91 vs. 1.67 ± 0.55; p=0.04).Conclusions:The PAPi in children post HTx correlates with known hemodynamic parameters. PAPi serves as a marker predicting renal dysfunction 1 year post HTx. Between HTx and 5 years post HTx, PAPi did not improve for the myopathy subgroup and declined significantly for the CHD subgroup suggesting that incorporating PAPi into existing risk models may substantially improve earlier implementation for advanced therapies and thus improve clinical outcomes.

AbstractRecent regulatory initiatives in the United States of America and Europe have transformed the paediatric clinical trials landscape by significantly increasing capital investment and paediatric trial volume. The purpose of this manuscript was to review the impact of these initiatives on the paediatric cardiovascular trials landscape when compared with other paediatric sub-specialties. We also evaluate factors that may have contributed to the success or failure of recent major paediatric cardiovascular trials so as to inform the optimal design and conduct of future trials in the field.

SIR: Both the articles on Mary Alice Evatt (September 2003) refer briefly to my parents, Sir Robert and Dame Pattie Menzies. May I make one or two brief comments? The [...]

A Myth-Busting, Real-Mother Layette List When I was pregnant with my first child, I took layette lists seriously. Very seriously. Glowing and excited (and, as a childless person, blessed with […]

Psychological adjustment may not be achieved by some women even years after breast cancer diagnosis. Although level of adjustment to diagnosis in the earliest (pretreatment) period is associated with future adjustment, limited research has explored this early period. Greater knowledge of women’s thoughts and behaviors as adjustment is initiated is needed to target interventions for women at risk for future adjustment problems.

Several letters to the editor are presented in response to articles in previous issues including Ben Kiernan's history of genocide, Blood and Soil," by Mervyn F. Bendle in the March 2008 issue, "Our Greatest Prime Minister," by John Stone in the March 2008 issue, and "The Mad Rush to Decarbonise," by Ray Evans in the March 2008 issue.

Features Finnish accordion player Kimmo Pohjonen. Information on Pohjonen's music releases; Description of Pohjonen's music; Experimentation with cutting-edge technology.

Introduction:Sudden cardiac death (SCD) burden in RASopathy patients (pts) with hypertrophic cardiomyopathy (RAS-HCM) is not known. We compared SCD events and transplant-free survival in RAS versus primary HCM (P-HCM) pts.Methods:The international 22-center retrospective cohort study (PRIMaCY) included 190 pediatric RAS-HCM and 568 P-HCM pts. The primary outcome was 10-year freedom from SCD events (composite of SCD, resuscitated sudden cardiac arrest, and appropriate shock from a prophylactic ICD), estimated using Kaplan Meier method.Results:Of 190 RAS-HCM pts, 82% had Noonan syndrome. Age at diagnosis was lower in RAS-HCM vs P-HCM (0.9 vs 9.7 yrs, p<0.001). There was no difference in baseline LV posterior wall or septal thickness, but LVOT gradient was higher in RAS-HCM vs P-HCM (30 vs 13mmHg, p<0.001). However, frequency of myectomy was not different in RAS-HCM vs P-HCM (15.2% vs 16.7%, p=0.55). Eighteen RAS-HCM pts died (4 SCD, 2 bradycardic arrests, 5 heart failure, 3 respiratory failure, 2 other) with lower 10-year transplant-free survival in RAS-HCM vs P-HCM (84.2% vs 91.6%, p=0.026). Although 10-year cumulative proportion of SCD events was lower in RAS-HCM than P-HCM (5.4% vs 15.1% respectively, p<0.001) (Figure 1), the median age at event was not different (12yrs in RAS-HCM vs 15.2yrs in P-HCM). Of 5 RAS-HCM pts with a SCD event, 4 died and 1 received a secondary prevention ICD. An additional 10 pts received a prophylactic ICD with no appropriate shock during follow-up. The 10-year cumulative proportion of prophylactic ICD was lower at 6.3% in RAS-HCM vs 27.2% in P-HCM (p<0.001).Conclusion:Transplant-free survival was lower in RAS-HCM than P-HCM with mortality related primarily to non-SCD events. Of the RAS-HCM patients with SCD events, 4 died without an ICD highlighting the need for better risk prediction models for both SCD and heart failure mortality in this population.

AbstractThree approaches to the study of children's reactions to the unfamiliar are reviewed with an emphasis on how the approaches differ in terms of measurement and interpretation of individual differences. Studies are reviewed which have particular relevance for the understanding of the role of temperament in predicting children's academic, social, and personal adaptation. Overall, it appears that differences in children's reactions to the unfamiliar may be more directly related to social and emotional adjustment than to academic adjustment per se. However, it is hypothesized that differences in children's reactions to the unfamiliar may indirectly influence adjustment in school through their influences on social and emotional adjustment. Suggestions are made for school psychologists and educators regarding approaches for assessment and modifications to the classroom environment to meet the needs of temperamentally diverse students.

The knowledge of medicine in Wales goes back to ancient Celtic times when it was banded down orally through many generations. During the 13th century, a Prince of South Wales, Rhys Gryg, instructed his court physician, Rhiwallon, to gather together the knowledge of medicinal plants and their methods of application and to write it down in Welsh. This would enable others to make use of the information both then and during the centuries that followed. Rhiwallon lived at Myddfai, a tiny village in Mid-Wales. He had three sons, who worked as physicians to the court and the neighbouring area. They became famous because of their skills in medicine and in due course a legend grew up around them. The countryside around Myddfai is still very rich in medicinal plants. They include Valeriana officinalis, Filipendula ulmaria, Scrophularia nodosa, Digitalis purpurea, Plantago spp., and Achiltea millefolium; the uses to which the Myddfai Physicians put these plants, and others, are described. 'Magical' plants such as Verbena officinalis and Viscum album, which have Druidic connections, are also discussed; some of these are still used today by herbalists. Many of the prescriptions of the Physicians are thus as relevant today as they were in the far past.

The article presents information on the drama "The Shoemaker's Holiday," written by fifteenth century British playwright Thomas Dekker. "The Shoemaker's Holiday," Dekker's joyful tribute to London's humbler citizenship, daunts production. It is an arcane comedy, weltered with local dialect and 16th century in-jokes, and its characterizations -- so differently conceived from those in Shakespearean comedy -- are easy to misconstrue. Dekker wrote for and about the working class, and his dramaturgy was in many ways fundamentally different from that of William Shakespeare, another dramatist of his age.

The article focuses on evangelism and television. Television is a filmic medium, composed of images and sounds carefully edited for presentation on a screen. Television is also ritual, because, it performs "one of the oldest, most traditional functions of images: to visualize common myths and to integrate the individual into a social whole." But there is another ingredient in the recipe that makes TV, and that is theater. And televangelism is not just theatrical in the general sense: it bears strong resemblance to a genre that was, in its time, just as popular: melodrama.

This article presents an interview with stage performers Mary Alice and James Earl Jones. When asked about their feelings working in an August Wilson play, Jones answer by stating that the play was unusual, while Alice comments that Wilson's characters are always complete. Jones has difficulties in modulating the character Troy's levels of energy. Alice approached her role was not too different from most character she played.

Presents letters to the editor referencing articles and topics discussed in previous issues. Opinion on a piece by John Russell which described the slow development for religious freedom in the Catholic Church; Insight concerning the lives of Australian dignitaries Robert and Pattie Menzies; Results of a survey on the alleged murder of journalists by the U.S. Pentagon in the 2003 Iraq War.

Discusses how words and comments directed to the physical appearance of a person can hurt.

Hotels are looking to property management systems to support front office and back office operations. One important part of a computer system often overlooked is the documentation that supports a [...]