Publications

Latin America is the world region with the highest rates of youth tobacco use and widest socioeconomic gaps, yet no data are available on smoking among Indigenous people, the largest disadvantaged group in the region. A self-administered survey of 3,131 8th grade youth enrolled in a random sample of 27 urban and rural schools was administered in 2004 in Jujuy, Argentina. Standard questions adapted from global surveys were used. Compared with youth of European background (11.4%; 95% CI 6.7-15.1), Indigenous (23.0%; 95% CI 21.0-25.0), and Mixed ethnicity (23%; 95% CI 18.9-27.1) youth had higher prevalence of current smoking. The odds of current smoking remained significantly elevated for Indigenous (OR 1.9; 95% CI = 1.1-3.3) and Mixed youth (OR 2.0; 95% CI 1.2-3.4) after controlling for confounders. Other risk factors that were associated with current smoking included: having any friends who smoke, repeating a grade in school, depressive symptoms in previous year, drinking any alcohol in the previous week and thrill seeking orientation. These results underscore the importance of social and cultural diversity aspects of the global tobacco epidemic.

BACKGROUND AND OBJECTIVE

Overuse injuries of the hand, wrist, forearm, and shoulder are common among endoscopists and may be from repetitive pinching and gripping forces or awkward posturing. In this pilot study, we evaluated distal upper-extremity musculoskeletal load during colonoscopy (1) to confirm the feasibility of performing ergonomic measurements in endoscopists and (2) to identify tasks that may contribute to overuse injuries.

DESIGN AND SUBJECTS

Three experienced gastroenterologists were evaluated during 3 colonoscopies each.

SETTING

Veterans Affairs Medical Center, San Francisco, California.

MAIN OUTCOME MEASUREMENT

Right-thumb pinch force using a thumb-force sensor and bilateral forearm-muscle activity using electromyography.

RESULTS

The mean duration of the 9 colonoscopies was 19.5 minutes. The highest mean (SD) right-thumb peak pinch forces occurred during left (10.4 [4.1] N) and right (10.1 [4.5] N) colon insertion, which exceeded the injury threshold of 10 N. Mean peak forearm-muscle activity was also greatest during left and right colon insertion. Activity of the left abductor pollicis longus, left extensor carpi radialis, and right extensor carpi radialis exceeded the American Conference of Industrial Hygienists (ACGIH) hand activity level (HAL) action limit. The left extensor carpi radialis was at the ACGIH HAL threshold limit.

LIMITATIONS

The small sample size, no force measurement for the left thumb, and all the gastroenterologists were men.

CONCLUSION

The pinch forces and forearm-muscle loads applied during routine colonoscopy may pose a risk for overuse injuries at the elbow and wrist.

Noonan syndrome is an autosomal dominant condition with variable phenotypic expression. Although an association between Noonan syndrome and various neoplasms has been identified, a relationship with primary glial or neuronal tumors of the central nervous system (CNS) has not yet been established. We describe the case of a 6-year-old male patient with Noonan syndrome and leptomeningeally disseminated low-grade mixed glioneuronal tumor. After a literature review, this case emerges as the third patient to present with Noonan syndrome and primary CNS glial tumor and the first with mixed glioneuronal tumor, indicating the possible association between these individual entities.

A childhood history of placement in the foster care system makes the emerging adult period more complicated and problematic in a variety of ways including meeting basic needs, such as housing and health. We conducted focus groups with 31 former foster youth in San Francisco and Oakland, California to explore their housing and health care circumstances since "aging out" of the foster care system. Five key themes were identified: 1) housing circumstances have direct and indirect impacts on access to health care; 2) housing instability can impede the flow of information between social services staff and youth; 3) housing circumstances and health care differed for men and women; 4) service agency rules and structures may be developmentally mismatched with participant needs; and 5) emerging adults experience repercussions of institutional life including the suspicion of authority and mistrust of medical providers.