Journal of General Practice

Stroke is the most feared risk associated with atrial fibrillation (AF). Both stroke and bleeding risk are independently
increased in patients with AF and renal dysfunction. The newer oral anticoagulants show similar or better stroke
prevention without further bleeding risk compared with vitamin K antagonist therapy and without its numerous
practical challenges. Nonetheless, renal monitoring is an important aspect of newer oral anticoagulant treatment.
This paper reviews management of patients with AF and renal impairment receiving newer oral anticoagulants, with
a specific focus on rivaroxaban given that it is now prescribed more often than warfarin by cardiologists in the US.

Background: A paucity of information exists in the literature that has seen a single study modeling macroeconomic indicators, murder and health indices (i.e., illness rate, health insurance coverage, health care utilization and mortality) in the English-speaking Caribbean. The current paper fills the gap in the literature. Objective: This paper examines how selected macroeconomic variables influence murder, mortality and illhealth. Methods: The data for this study are taken from publications of different governmental organizations, responsible for the collection of pertinent data for the government to carry out policy planning. Ordinary least square regression analyses were used to establish the model for 1) mortality, 2) murder and 3) ill-health. Results: There is a fluctuation of murder rates between the decades in the study period as evidenced by the fact that the average number of murders in Jamaica between 1969 and 1981 was 266. The following decade (1980-1989) saw an 85.3% increase, which subsequently saw a 43.4% reduction by the third decade of the study period (1990-1999). The last decade (2000-2009) saw a 93.5% increase in murders. For the studied period, there was a geometric progression in murders compared to a cyclical change in mortality. There was a strong correlation between murder and health insurance coverage (rs=0.960; P=0.0001), inflation (rs=-0.861; P=0.0001), exchange rate (rs=0.950; P=0.0001); a moderate relationship between mortality and health care utilization (rs=0.654; P=0.001) and no bivariate relationship existed between murder and illness (rs=-0.411, P=0.090). Conclusion: The reality is government should have a coherent policy in place to address these events, as every life lost through murder is important and represents a reduction in potential contribution to economic growth and development.

Abstract Background and Objectives: Linking primary care practices to community entities is critical for providing comprehensive and continuous care. The patient centered medical home (PCMH) should facilitate linkages to the community. Our study aims to understand what challenges pediatric primary care practices in Florida face in developing these linkages. Methods: Interviews were conducted with three-person core project teams working in 20 pediatric practices across Florida. All practices are participating in a longitudinal, PCMH demonstration project. Results: At baseline, most practices reported positive connections with specialists, but about half reported insurance as the main barrier. Practices reported both negative and positive aspects of their connection to hospitals and emergency rooms. While some practices saw the emergency room as source of referral back to their practice, others felt that hospitals or emergency rooms did not communicate well or collaborate in patient care. Most practices felt that current communication with traditional and special schools was insufficient (paperwork-based) and infrequent (as-needed basis), and that a more formal and proactive system was needed. While most practices were able to provide numerous examples of their involvement in the community, their responses indicated a lack of organization or planning for future events. The majority of practices found it easier to describe one-time, past events rather than provide a list of current or recurring projects. Conclusions: Integration on all levels is fundamental to the PCMH. Our study demonstrates that PCMH facilitators and accreditation agencies must take into account the varying barriers and infrastructures present in a practice’s community when providing effective strategies for coordinated care.

Human immunodeficiency virus (HIV) infection is a global public health issue and a major problem in sub-
Saharan Africa. This study was a descriptive cross-sectional study designed to determine the prevalence of
cardiovascular abnormalities in HIV positive patients using echocardiography. The study was carried out at the
Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Treatment naïve HIV positive patients aged between 16
and 82 years were recruited from the HIV clinic using simple random sampling. Disease history documentation,
physical examination and trans-thoracic echocardiography were performed on all study participants. Two hundred
(200) patients were studied. They were aged between 16 and 82 years with the mean age (± SD) of 40.6 (± 10.5)
years. There were more females (74.5%; n=149) than males (25.5%; n=51). The overall prevalence of
cardiovascular abnormalities was 55.5% (n=111). The cardiovascular abnormalities seen were pulmonary
hypertension (38.50%), dilated cardiomyopathy (34%), pericardial effusion (23.50%), left ventricular systolic
dysfunction (17.50 %) and left ventricular diastolic dysfunction (9.50%). Moderate pericardial effusion was seen in
9.5% of the patients whilst minimal pericardial effusion was seen in 14%. No patient was seen with severe
pericardial effusion. For the patients with pulmonary hypertension, the mean (± SD) right ventricular systolic
pressure (RVSP) was 51.5 (± 7.8) mmHg, (range; 40-70 mmHg). In conclusion, there was a high prevalence of
cardiovascular abnormalities among adult HIV positive patients attending the HIV clinic at KATH, Kumasi, Ghana.
The main cardiovascular abnormalities were pulmonary hypertension, dilated cardiomyopathy and pericardial
effusion.

A 67-year-old woman was admitted with dyspnea. The cheat X-ray showed marked cardiomegaly and the echocardiography revealed diffuse massive pericardial effusion but no finding of vegetation on valves. Clinical sign of cardiac tamponade was not observed. Values of white blood cell and C-reactive protein were 23,900/μL and 16.2 mg/dL, respectively. Immediately, pericardiocentesis was performed. Pericardial effusion was yellowish purulent exudate and Streptococcus pneumoniae was detected in culture. The early pericardial drainage and the effective doses of intravenous antibiotics and γ-globulin were successful for the treatment of this bacterial pericarditis, and no more surgical procedure was needed. Neither recurrence of inflammation nor constrictive pericarditis was developed after discontinuation of antibiotics during the follow-up period for over three years at the outpatient clinic. In this case, an infection route was unknown since pneumonia, empyema, or other focus of infection was not found. Although she had an upper respiratory infection one year prior to this pericarditis, their association was unclear. She was previously healthy and was not a compromised host. This case is thought to be rare bacterial pericarditis with slow progression in the recent antibiotic era.

Abstract Background: Domestic abuse against a female is considered an anomalous deportment; however it is still an obnubilated quandary. Its prevalence rate is very high reaching up to 59% in certain communities. This study was done with the main objective of ascertaining the rate of women abuse in both Al-Dammam and Al-Ahsa cities of Saudi Arabia and to explore the associated risk factors to it. Materials and methods: A cross-sectional study was conducted on a convenient sample of 348 married Saudi women aged between 18 and 50 years, who have one child or more and live in the designated cities. The data were amassed by betokens of a pre-designed questionnaire. Results: The prevalence of women abuse was found to be around 19%, but reached to 33% when added to it the response of women to the abuse cognate questions. The highest rate was among women aged 40 years and older. The most mundane type of abuse was that of multiple types that accounted to 49% (which included verbal, physical and others). Vituperation accounted for 35.8% and physical, emotional, and psychological accounted for 7.5% each. Abuse was higher among lower educated couples and in families with poor economic status. Only a moiety of the abused women sought help, and most did so from their families (71%) and friends (17.8). Very few reported to the police. Conclusion: The prevalence of abuse against women is underestimated, as many women did not admit frankly being abused while they did answer abuse cognate questions. Since this type of violence affects the stability of the family and the well-being of the victim, it is recommended to establish utilize multi disciplinary programs aiming at raising the cognizance level of the society against this eccentric demeanor. Educating current and future couples and opportune training of health care providers