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Return Visit (return + visit)
Selected AbstractsLinking return visits and return migration among Commonwealth Eastern Caribbean migrants in TorontoGLOBAL NETWORKS, Issue 1 2004David Timothy Duval Return visits are periodic but temporary sojourns made by members of migrant communities to their external homeland or another location where strong social ties exist. As a result, the conceptual framework in this article revolves around transnationalism as the return visit is shown to be a transnational exercise that may facilitate return. Using data from ethnographic fieldwork, three themes highlight the link between return visits and return migration: (1) the need to facilitate ties such that relationships are meaningful upon permanent return; (2) the functional nature of the return visit, such that changes are measured and benchmarked against what is remembered and internalized by the migration after the migration episode; and (3) the knowledge that return visits aid in reintegration. [source] Recurrent Respiratory Papillomatosis: A Longitudinal Study Comparing Severity Associated With Human Papilloma Viral Types 6 and 11 and Other Risk Factors in a Large Pediatric Population,THE LARYNGOSCOPE, Issue S104 2004Brian J. Wiatrak MD Abstract Objectives/Hypothesis: A database was developed for prospective, longitudinal study of recurrent respiratory papillomatosis (RRP) in a large population of pediatric patients. Data recorded for each patient included epidemiological factors, human papilloma virus (HPV) type, clinical course, staged severity of disease at each surgical intervention, and frequency of surgical intervention. The study hypothesizes that patients with HPV type 11 (HPV-11) and patients younger than 3 years of age at diagnosis are at risk for more aggressive and extensive disease. Study Design: The 10-year prospective epidemiological study used disease staging for each patient with an original scoring system. Severity scores were updated at each surgical procedure. Methods: Parents of children with RRP referred to the authors' hospital completed a detailed epidemiological questionnaire at the initial visit or at the first return visit after the study began. At the first endoscopic debridement after study enrollment, tissue was obtained and submitted for HPV typing using polymerase chain reaction techniques and in situ hybridization. Staging of disease severity was performed in real time at each endoscopic procedure using an RRP scoring system developed by one of the authors (B.J.W.). The frequency of endoscopic operative debridement was recorded for each patient. Information in the database was analyzed to identify statistically significant relationships between extent of disease and/or HPV type, patient age at diagnosis, and selected epidemiological factors. Results: The study may represent the first longitudinal prospective analysis of a large pediatric RRP population. Fifty-eight of the 73 patients in the study underwent HPV typing. Patients infected with HPV-11 were significantly more likely to have higher severity scores, require more frequent surgical intervention, and require adjuvant therapy to control disease progression. In addition, patients with HPV-11 RRP were significantly more likely to develop tracheal disease, to require tracheotomy, and to develop pulmonary disease. Patients receiving a diagnosis of RRP before 3 years of age had significantly higher severity scores, higher frequencies of surgical intervention, and greater likelihood of requiring adjuvant medical therapy. Patients with Medicaid insurance had significantly higher severity scores and required more frequent surgical debridement. Birth by cesarean section appeared to be a significant risk factor for more severe disease and necessity of more frequent surgical intervention. Conclusion: Statistical analysis of the relationships among epidemiological factors, HPV type, and clinical course revealed that patients with HPV-11 and patients younger than 3 years of age at RRP diagnosis are prone to develop more aggressive disease as represented by higher severity scores at endoscopic debridement, more frequent operative debridement procedures per year, a greater requirement for adjuvant therapy, and greater likelihood of tracheal disease with tracheotomy. [source] Front and Back Covers, Volume 23, Number 1.ANTHROPOLOGY TODAY, Issue 1 2007February 200 Front and back cover caption, volume 23 issue 1 Front cover A Dutch participant in the reality television series Groeten uit de rimboe, in which Dutch and Belgian families immerse themselves in the daily life of the world's ,most primitive tribes'. Some time afterwards, their hosts pay a return visit to experience life in Europe, screened on television in the sequel Groeten terug. The two series have been subject to heated debate in the Dutch media, having been both lauded as unpretentious entertainment and condemned as unethical ,popular anthropology'. The attention of Myrna Eindhoven, Laurens Bakker and Gerard Persoon was first drawn to the series when a family was sent to Mentawai, where all three have done fieldwork. While they themselves are critical of the unashamed focus on entertainment, they became intrigued by the reactions of other anthropologists to the series. Here they connect this case from the Netherlands to the ongoing debate on ,popular anthropology' in ANTHROPOLOGY TODAY, triggered by the UK series Tribe. Dutch anthropologists have mostly dismissed the series as ,not anthropology', criticizing it as exploitative and as ethnocentric. But do anthropologists have the authority to define ,popular anthropology'? How do we come to terms with blatant commercialization of our fieldwork sites, and their conversion into exotic locations for popular entertainment? Back cover NATION-BUILDING IN EAST TIMOR East Timor celebrates its Independence Day on 20 May each year. The day forms the backdrop for the largest annual encounter between the political centre and the periphery. In this photo, an elder (katuas) member of Fretilin, the largest political party, blends traditional and modern at the Independence Day celebrations in the capital, Dili, in 2005. As an exemplar of the United Nations' capacity for ,nation-building', the Democratic Republic of Timor Leste (or ,East Timor' as it is more popularly known) developed into something of a ,poster boy' for the United Nations from the day it became a sovereign nation on 20 May 2002. But in April 2006, some months after the last remaining UN staff had left, violence in the streets of the capital began to undermine social and political stability, resulting in the overthrow of prime minister Mari Alkatiri. Under the more engaged leadership of his successor, José Ramos-Horta, the threat of unrest has abated to some extent. Nevertheless, the country faces an array of serious problems , political, social and economic. In his article in this issue, David Hicks draws on his anthropological fieldwork to highlight the widening gap between the ,centre' and the ,periphery'. Hicks argues that the former embodies the institutions and quasi-Western values professed by the national leaders in Dili, while the latter centres around the traditional, largely indigenous values of the country's local communities, who comprise the overwhelming majority of the population. Although already latent before the United Nations left, this widening divergence in values is eroding the political integrity of the first nation-state to become a member of the United Nations in the 21st century, and if it continues to grow, will call into question the ability of the United Nations to ,manufacture' nation-states. Anthropology has an important role to play in highlighting and analysing the implications of grassroots discrepancies between local populations and political elites. More than this, it has a role to play in confronting the international community with the ethical and other consequences of its increasingly regular interventions in third countries. [source] Hospital Characteristics and Emergency Department Care of Older Patients Are Associated with Return VisitsACADEMIC EMERGENCY MEDICINE, Issue 5 2007DrPH, Jane McCusker MD ObjectivesTo explore hospital characteristics and indicators of emergency department (ED) care of older patients associated with return visits to the ED. MethodsProvincial databases in the province of Quebec, Canada, and a survey of ED geriatric services were linked at the individual and hospital level, respectively. All general acute care adult hospitals with at least 100 eligible patients who visited an ED during 2001 were included (N= 80). The study population (N= 140,379) comprised community-dwelling individuals aged 65 years and older who made an initial ED visit in 2001 and were discharged home. Characteristics of the hospitals included location, number of ED beds, ED resources, and geriatric services in the hospital and the ED. Indicators of ED care at the initial visit included day of the visit, availability of hospital beds, and relative crowding. The main outcome was time to first return ED visit; the authors also analyzed the type of return visit (with or without hospital admission at return visit, and return visits within seven days). ResultsIn multilevel multivariate analyses adjusting for patient characteristics (sociodemographic, ED diagnosis, comorbidity, prior health services utilization), the following variables were independently associated (p < 0.05) with a shorter time to first return ED visit: more limited ED resources, fewer than 12 ED beds, no geriatric unit, no social worker in the ED, fewer available hospital beds at the time of the ED visit, and an ED visit on a weekend. ConclusionsIn general, more limited ED resources and indicators of ED care (weekend visits, fewer available hospital beds) are associated with return ED visits in seniors, although the magnitude of the effects is generally small. [source] An Interdisciplinary Initiative to Reduce Radiation Exposure: Evaluation of Appendicitis in a Pediatric Emergency Department With Clinical Assessment Supported by a Staged Ultrasound and Computed Tomography PathwayACADEMIC EMERGENCY MEDICINE, Issue 11 2009Naresh Ramarajan MD Abstract Objectives:, In the emergency department (ED), a significant amount of radiation exposure is due to computed tomography (CT) scans performed for the diagnosis of appendicitis. Children are at increased risk of developing cancer from low-dose radiation and it is therefore desirable to utilize CT only when appropriate. Ultrasonography (US) eliminates radiation but has sensitivity inferior to that of CT. We describe an interdisciplinary initiative to use a staged US and CT pathway to maximize diagnostic accuracy while minimizing radiation exposure. Methods:, This was a retrospective outcomes analysis of patients presenting after hours for suspected appendicitis at an academic children's hospital ED over a 6-year period. The pathway established US as the initial imaging modality. CT was recommended only if US was equivocal. Clinical and pathologic outcomes from ED diagnosis and disposition, histopathology and return visits, were correlated with the US and CT. ED diagnosis and disposition, pathology, and return visits were used to determine outcome. Results:, A total of 680 patients met the study criteria. A total of 407 patients (60%) followed the pathway. Two-hundred of these (49%) were managed definitively without CT. A total of 106 patients (26%) had a positive US for appendicitis; 94 (23%) had a negative US. A total of 207 patients had equivocal US with follow-up CT. A total of 144 patients went to the operating room (OR); 10 patients (7%) had negative appendectomies. One case of appendicitis was missed (<0.5%). The sensitivity, specificity, negative predictive value, and positive predictive values of our staged US-CT pathway were 99%, 91%, 99%, and 85%, respectively. A total of 228 of 680 patients (34%) had an equivocal US with no follow-up CT. Of these patients, 10 (4%) went to the OR with one negative appendectomy. A total of 218 patients (32%) were observed clinically without complications. Conclusions:, Half of the patients who were treated using this pathway were managed with definitive US alone with an acceptable negative appendectomy rate (7%) and a missed appendicitis rate of less than 0.5%. Visualization of a normal appendix (negative US) was sufficient to obviate the need for a CT in the authors' experience. Emergency physicians (EPs) used an equivocal US in conjunction with clinical assessment to care for one-third of study patients without a CT and with no known cases of missed appendicitis. These data suggest that by employing US first on all children needing diagnostic imaging for diagnosis of acute appendicitis, radiation exposure may be substantially decreased without a decrease in safety or efficacy. [source] | |||||||||||||