Asunto(s)
Sífilis Congénita/diagnóstico , Antibacterianos/administración & dosificación , Humanos , Recién Nacido , Masculino , Nueva Zelanda , Penicilina G/administración & dosificación , Sífilis Congénita/tratamiento farmacológico , Resultado del Tratamiento , Treponema pallidum/aislamiento & purificaciónRESUMEN
In the public sphere, issues are like icebergs. This somewhat hackneyed metaphor illustrates that, while one facet of an issue is perceived, what is not seen is the hidden substructure of power and culture that form and reinforce it, buoying the issue to prominence above the surface.
Asunto(s)
Accesibilidad a los Servicios de Salud , Nativos de Hawái y Otras Islas del Pacífico/etnología , Médicos/organización & administración , Racismo , Competencia Cultural , Humanos , Nueva Zelanda/etnologíaAsunto(s)
Servicios de Salud del Niño/economía , Salud Infantil , Disparidades en Atención de Salud/economía , Derechos Humanos , Guías de Práctica Clínica como Asunto , Australia , Niño , Defensa del Niño/legislación & jurisprudencia , Servicios de Salud del Niño/estadística & datos numéricos , Femenino , Política de Salud/legislación & jurisprudencia , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Evaluación de Necesidades , Nueva Gales del Sur , Nueva Zelanda , Pediatría/normas , Formulación de Políticas , Publicaciones/normas , Sociedades MédicasRESUMEN
AIM: The aim of this study was to investigate whether racial disparities in healthcare exist within a New Zealand pediatric surgical outreach service in a high indigenous Maori population. METHODOLOGY: This retrospective study assessed all pediatric surgical procedures performed within a secondary center in New Zealand between May 2014 and May 2016. The days between the date of surgery booking on the waiting list and actual date of surgery were calculated and compared to their corresponding elective surgery waiting target times set by the New Zealand Ministry of Health (MoH). Patient demographic data were collated to then identify any discrepancy between ethnic groups. RESULTS: A total of 203 pediatric surgical procedures were performed on 193 patients. Of the 194 (95%) procedures that were included in the study, 30 breached a maximum waiting time. Though this represented a small proportion of patients, Maori were significantly over represented in this group. CONCLUSION: The majority of our patients with delayed elective surgery were of Maori ethnicity, for reasons not entirely accounted for by common socioeconomic determinants of health. Our study suggests the possibility of innate systemic causes not detected by standard models of health. However, further research with larger cohorts is needed. LEVEL OF EVIDENCE: III.
Asunto(s)
Relaciones Comunidad-Institución , Atención a la Salud/etnología , Pacientes Internos , Grupos Raciales , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Niño , Femenino , Humanos , Lactante , Masculino , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Factores SocioeconómicosRESUMEN
A 9-month old infant presented in a state of shock to a district hospital. She was subsequently referred to the regional tertiary hospital. On admission, bruises were noted on the vertex of the skull. Retinal hemorrhages were present on ophthalmological examination. CT scan of the brain showed poor grey-white matter differentiation with apparent frontoparietal fractures of the skull. Her case was subsequently referred to the relevant authorities as it was suspicious for nonaccident injury (NAI). Her condition deteriorated and she died the next day. Postmortem examination showed that the bruises on the vertex were caused by rapid widening of the sutures of the skull, caused by rising intracranial pressure. There was no skull fracture or evidence of trauma. Histological examination of the brain showed meningitis which had extended to the optic nerve sheath. Hemorrhages were noted in the retinas as well as the optic nerve sheath. An incidental congenital disorder of glycosylation (CDG) was diagnosed on brain histology and confirmed by metabolic tests. Retinal hemorrhages are known to occur in head injuries especially in association with NAI. In this case, suspicion of NAI was further augmented by the presence of apparent bruises on the head. The full postmortem examination showed no evidence of injuries and instead showed that the child was suffering from meningitis. Blood culture grew Group A Streptococcus pyogenes. The underlying mechanisms for such a presentation and the association with CDG are discussed.