STUDY DESIGN: Retrospective cohort design. PURPOSE: This study aimed to determine whether recombinant human bone morphogenic protein 2 (rhBMP-2) reduces total perioperative blood loss during lumbar and thoracic fusion. OVERVIEW OF LITERATURE: Previous studies on rhBMP-2 versus iliac crest bone grafting in thoracic and lumbar fusions have yielded mixed results regarding reductions in blood loss and have largely neglected the postoperative period when analyzing total blood loss. Additionally, these studies have been limited by heterogeneity and sample size. METHODS: We analyzed the blood loss patterns of 617 consecutive adult patients undergoing lumbar and/or thoracic fusions requiring subfascial drain placement at a single institution from January 2009 to December 2016. Patients were divided into BMP and non-BMP cohorts, and a propensity score analysis was conducted to account for the differences between cohorts. RESULTS: At a per-level fused basis, the BMP group exhibited a significant reduction in the intraoperative (66.1 mL per-level fused basis; 95% confidence interval [CI], 127.9 to 4.25 mL; p=0.036) and total perioperative blood loss (100.7 mL per-level fused basis; 95% CI, 200.9 to 0.5 mL; p=0.049). However, no significant differences were observed in an analysis when not controlling for the number of levels or when examining the postoperative drain output. CONCLUSION: RhBMP-2 appears to reduce both intraoperative and total blood loss during lumbar and thoracic fusions on a per-level fused basis. This total reduction in blood loss was achieved via intraoperative effects because RhBMP-2 had no significant effect on the postoperative drain output.
Adult ; Bone Transplantation ; Cohort Studies ; Humans ; Population Characteristics ; Postoperative Period ; Propensity Score ; Retrospective Studies ; Sample Size ; Spinal Fusion

Adult ; Aged ; Alcohol Drinking ; adverse effects ; China ; epidemiology ; Demography ; Female ; Geography ; Humans ; Hypertension ; epidemiology ; prevention & control ; Male ; Mass Screening ; Middle Aged ; Prevalence ; Risk Factors ; Smoking ; adverse effects

Objective: To investigate levels of awareness of dengue among the inhabitants of Queensland (QLD), a dengue-prevalent state in the north east of Australia. Methods: A computer-assisted telephone interviewing survey was conducted in mid 2014. A total of 1. 223 randomly selected respondents (≥ 18 years) across QLD completed a structured questionnaire covering all aspects of dengue. Results: 97.55% had heard of dengue and participated further. Among them, 54.70% had travelled overseas (48.11% to dengue-risk countries) in the last five years. A total of 94.47% said transmission is by mosquito bite. In addition, 84.83% knew of current transmission of dengue in QLD, while 80.97% knew the focus is Far North and North QLD. Furthermore, 2.35% and 8.97% had experienced an infection in their life or that of their immediate family/partner, respectively. 85.03% identified correctly at least one means of prevention. A total of 69.72% advised to use insect repellent, wear covered clothing and avoid visiting mosquito-prone areas while 20.93% advised fumigation and clearing water containers around residences. There was a significant difference (P < 0.05) between residents of South East QLD and the rest of QLD regarding knowledge of prevention. However, such awareness was not affected significantly by overseas travel (P > 0.05). Conclusions: Although many people throughout QLD have heard of dengue, about 15% appear unaware of local transmission, its symptoms and of methods to reduce risk of infection. A lack of knowledge regarding prevention of mosquito breeding is evident in South East QLD, where dengue is not currently reported. The study suggests that future dengue awareness campaigns should target communities in both endemic and potentially endemic areas throughout Queensland.

AIM: This study aims to explore the reintegration experiences of returning migrant healthcare workers in the Philippines. BACKGROUND: Return migration and reintegration of healthcare labor force is a relevant part of the migration process valuable in the improvement of human capital in source countries through transfer of knowledge and skills. However, this research field has received little attention in terms of policy, program, and research development. Hence, there is a paucity of information in the Philippines describing the reintegration experiences of returning migrant healthcare workers despite its maturity in health worker migration. METHODS: A qualitative case study approach was utilized in this study. Initially, an online literature review of electronic databases and grey literature regarding reintegration of migrant workers in the Philippines was performed. This was followed by online in- depth interviews among purposively selected potential, current, or returning nurses, rehabilitation therapists, and caregiver health worker migrants through Zoom web conferencing platform. Government, private, and non-government institutions involved in the migration of health workers were also invited to participate in online focus group discussions and key informant interviews. An inductive content analysis using matrices was utilized to determine relevant descriptive codes, categories, and themes. RESULTS: Return migration and reintegration is perceived as an uncommon phenomenon among healthcare worker migrants. Nonetheless, motivations and grounds of opting to return and reintegrate in the Philippines can mostly be due to personal reasons or entrepreneurial aspirations. Upon return, they successfully held teaching and training positions, engaged in business through specialized clinics, or established professional associations. There was largely a perceived lack of awareness of government efforts on reintegration as it was felt that services and assistance were limited. Further observed restraints to return migration include lower wages in the Philippines, lack of knowledge on financial management, paucity of skills and qualifications recognition acquired overseas in their home country, and absence of professional network support. The COVID-19 pandemic also positively or negatively influenced healthcare worker migration. CONCLUSION This study highlighted the motivations and restraints of health worker migrants in returning to reintegrate in the Philippines. The availability and deficiency in policies, programs, and services for returning migrant workers were also emphasized. In addition, the aspects and prospects of return migration and reintegration, as well as the challenges posed by the COVID-19 pandemic on healthcare worker reintegration was identified. The Philippine government and other concerned agencies need to ensure a supportive environment that will foster a positively conducive reintegration experience for returning healthcare worker migrants.
Philippines ; Qualitative Research