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PubMedDate not supplied

Comparing easy and accessible parameters of glycemic control in type 2 diabetes.

BACKGROUND: HbA1c is considered the gold standard of long-term glycemic control and is recommended as a routine test for every diabetic patient. However, its common use in clinical practice has some problems related to lack of standardization and its relative cost. Recent studies have suggested, that postprandial blood glucose could be better than a fasting sample, as a marker of diabetes control. The objective of the present study was to evaluate the relative value of plasma glucose samples at different times of the day, and easy and accessible programs for home blood and urinary glucose measurements compared with HbA1c in assessing the mean glycemic control of type 2 diabetic patients. METHODS: Sixty type 2 diabetic patients were instructed to do home blood and urine glucose monitoring for two months, at the end, plasma glucose profiles were obtained. RESULTS: The mean of all the capillary BG measurements had the best correlation with the HbA1c (r = 0.84, p < 0.001), followed by the mean of the capillary BG measurements before breakfast and supper (r = 0.82, p < 0.001), and the 2 hr. postbreakfast plasma glucose (r = 0.79 p < 0.001). The fasting PG had a low correlation (r = 0.65, p < 0.001), but a good sensitivity to predict a fair or a poor metabolic control. Diabetes duration and type of treatment explained 17% and 28% of variance in HbA1c levels. CONCLUSIONS: A bimonthly fasting PG correlated well with the glycosylated hemoglobin and is the easiest and cheapest way of monitoring glycemic control in type 2 diabetic patients with some preserved insulin reserve (diabetes for less than 10 years and on treatment with only one hypoglycemic agent). A sample of capillary BG, fasting, once per week correlates better with the HbA1c than a fasting PG every 2-3 months. The 2 hr and 5 hr postbreakfast PG have a good correlation with the HbA1c, but are not a substitute for doing BG monitoring. Glycosuria may be a useful parameter to rule out a fair or poor metabolic control in some patients.

Adult↗
PubMed2002

Anti-HIV therapy update.

Recently there have been good and bad news from the anti-HIV drug development front. First the good news, the Food and Drug Administration (FDA) recently approved tenofovir (Viread) for the treatment of HIV disease. This is welcome news for people who need a new drug to put together a second or third line regimen and may even be an important new choice for first line therapy. Additionally, a long awaited expanded access program for the fusion inhibitor T-20 (pentafuside) has been announced. The bad news is that the program is so small that it will provide drug to only 168 people in the United States, in the first stage of the program. This will be gradually increased as more drug becomes available but a wider expanded program is still a long way off.

Anti-HIV Agents↗
PubMedDate not supplied

[A pilot study about implementation in Romanian medical activity of diagnosis related groups classification].

UNLABELLED: The inpatient and outpatient classification in homogeneous groups (Diagnosis Related Groups--DRGs and Ambulatory Patient Groups--APGs) it is usually used for the medical resources' management and in second place for the structure's and the sanitary system's function evaluation, for the establishment of necessities and priorities in medical care of a population, for the establishment of the used resources etc. These elements given by the method are essential for a sanitary reform. In this whey the possibility of implementation for the method in Romanian medical practice, we've proposed to evaluate it in a pilot study. METHODS: The study was made on an adult population sample from Cluj-Napoca. It was made out of 311 subjects. The data were taken in unitary mode using a record questionnaire. The database was performed in the ACCESS program. For the statistic there were used the information pack EpiInfo version 6, 04. 1996. The reference year was 1997. To observe the evolution of the phenomenon we compared with a control group from 1987 composed by matching 1:1. RESULTS: In the sample females were significatively dominant (65.4%, p < 0.00001) and elders (the age group of 60-69 years represent 54%, p < 0.00001). In 1987 the elders > or = 60 years were the once how had in a significantly way more often medical care both in and outpatient. In 1997, the medical care for adults was close to the once for elders. In evolution, for a 10 year period, the ambulatory assistance decreased and the specialized assistants in the hospital increased (unique and multiple). The risk of hospitalization in 1997 compared to 1987, is significatively bigger: OR = 2.56 (IC 95%: 1.61-4.09), p < 0.001. The pathology assisted in ambulatory and in hospital was represented more often by the cardiovascular system affections (CMD 05-61.1%) in witch the arterial hypertension is dominant (DRG 191). CONCLUSIONS: To produce DRGs and APGs, in the actual sanitary system, from the university center Cluj-Napoca it is possible, but the development of the actual informational system is necessary. The implementation of the classification method needs from the medical practice side it's standardization because the homogeneous patients consume the same quantity of resources from the medical point of view. The medical service separation in smaller and bigger hospitalization is necessary.

Adult↗
PubMed2002

The use of infliximab in academic rheumatology practice: an audit of early clinical experience.

OBJECTIVE: To audit a first clinical experience of treating rheumatic disease patients with infliximab in the setting of an academic tertiary care rheumatology practice. METHODS: The infusion history of patients referred to the McGill University Health Centre during the first 18 month period of a special access program for treatment with infliximab, a tumor necrosis factor-a antibody, was audited for disease characteristics, dosing schedule for infliximab, concomitant treatments, response rate, and side effect profile. RESULTS: Forty-one patients received a total of 300 infusions of infliximab over a period of 9 +/- 5 months (mean +/- standard deviation). Rheumatic disease indications were rheumatoid arthritis in 30, spondyloarthropathy in 6, psoriatic arthritis in 2, juvenile onset polyarthritis in 2, and scleroderma in one. Disease duration was 17 +/- 11 years. Concomitant treatment with steroids and methotrexate was present in 68% and 54%, respectively. Infliximab treatment was continued beyond 5 infusions or 22 weeks in 63%. Of the 26 patients continuing treatment, adjustment to dosing and/or interval schedule of infusions was made in 58%. The clinical response rate was moderately to greatly improved in 96%. Severe side effects considered directly related to the treatment were observed in 6 (15%) patients; less severe side effects, which did not preclude continuation of treatment but frequently required medical intervention, were noted in 93%. CONCLUSION: Infliximab is a valuable treatment for patients with resistant rheumatic diseases in the short term. Both the serious, and the frequent, more benign complication rate observed in this group of patients should alert physicians to be vigilant in the routine care of patients treated with infliximab.

Antibodies, Monoclonal↗
PubMed1990

[Guidelines for electronic-data-processing-controlled serial diagnosis of donor blood samples].

UNLABELLED: Increasing performance figures and the necessity to save expenses oblige transfusion services to automatize their donors' laboratory examination. Sufficient hard- and software for sample distribution and processing is now available. Following aspects should be regarded when switching to automatic serial screening: SAFETY: The identity of blood-donor, donation and laboratory result will be achieved by machine readable labeling and on-line communication between working-stations and central administration. Flexibility: Easy automatic selective laboratory screening will be possible using special barcodes including sample identification and working orders. A modular hardware concept with easily accessible programming control allows it to implement new devices or methods. Ergonomy: Automatic sample processing including selective screening and simultaneous operating robotic sample processors increase working quality, sample output and time benefits. Economy: Improved working conditions will result in saving reagents and compensating staff limitations.

Blood Banks↗
PubMed1991

Incidence and causes of maternal mortality in five Kampala hospitals, 1980-1986.

This report presents results of a descriptive study to estimate the mortality rate, identify the type and the causes of maternal deaths. The study was conducted in 1987 in Kampala hospitals for a period covering seven years from 1st January 1980 to 31st December, 1986. The non abortion maternal mortality rate (NAMMR) was 2.65 per 1000 deliveries while the abortion related maternal mortality rate (ARMMR) was 3.58 per 1000 abortions. There was a statistically significant increase in NAMMR while the increase in ARMMR was almost significant over the seven year period. Of all maternal deaths, 80 per cent were non abortion while 20 per cent were abortion related. The commonest immediate causes of death, in order of importance, were sepsis, haemorrhage, ruptured uterus, anaesthesia and anaemia. The commonest patient management factors which contributed to death, in order of importance, were lack of blood for transfusion, lack of drugs and intravenous fluids, theatre problems and doctor related factors. We feel that a lot happens to the pregnant mother before she finally reaches a health unit for delivery and that there is a great need to improve on the community's gynaecological and obstetrical services as well as ambulance and emergency services. We also feel that maternal mortality in developing countries could be reduced if the health workers were imaginative in respect to each patient, tried not to operate as though they were working in a developed country, and created relevant solutions for the local problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1991

Protecting reproductive health and choice.

Women and men have special needs in rehabilitation. Women's needs, however, have received far less attention in the scientific community and medical literature. This section, edited by Sandra Cole, PhD,(*) highlights some of the unique concerns of women who live with physical disabilities.

Decision Making↗
PubMedDate not supplied

Maternal health care utilization in Jordan: a study of patterns and determinants.

This article analyzes the patterns and determinants of maternal health care utilization in Jordan, using data from the Jordan Fertility and Family Health Survey of 1983. The study focuses on the 2,949 women who had a child in the five years preceding the survey. Through multivariate analyses of differentials in the utilization of prenatal care and health care at delivery, the study assesses the effect of sociodemographic factors, including residence, education, parity, and standard of living. The coverage of maternal health care in Jordan is discussed in relation to the overall organization of health services, the various providers of care, and the role of cultural factors.

Adolescent↗
PubMed1991

Changing sex ratio of mortality in the Semai Senoi, 1969-1987.

An excess of male over female deaths is characteristic of modern national populations, whereas in some high-mortality societies female mortality exceeds that of males. Among the Semai Senoi, a Malaysian Orang Asli ("aboriginal") population, women experienced higher mortality than males in the decades before 1969. This differential occurred in all age classes older than 15 years so that the sex ratio progressively increased with age. A recent (1987) restudy of the Semai population found that sex-specific differential mortality is much reduced. A comparison of the 1969 and 1987 life tables shows a sharp shift in the sex ratios of mortality for the post-15-year-old age classes (the geometric means of age classes 15-44 were 0.768 in 1969 and 0.997 in 1987) so that male and female expectations of further life at age 15 are now nearly identical. In contrast to the best-known cases of high female mortality (mostly in South Asia), Semai sex differential mortality does not include the childhood ages. The Semai have traditionally been relatively sexually egalitarian, and sex bias in care has not occurred. Analysis of sex-specific causes of death for the pre-1969 population suggests that maternal mortality is the major cause of the excess female deaths. The reduced number of maternal deaths seems largely due to better health care, particularly the availability of hospital services. Interestingly, the reduction in female mortality has occurred simultaneously with increased fertility, and overall mortality has continued at relatively high levels (eO less than 36). Thus, rather than forming a component of a unitary demographic transition, declining sex differences in mortality can be accounted for by a specific factor, better maternal care.

Adolescent↗
PubMed1991

Possible reasons for non-completion of immunization in an urban settlement of Papua New Guinea.

A study to identify possible reasons for non-completion of immunization among children was carried out in an urban settlement of Port Moresby. It was found that the children's mothers lacked basic understanding about immunization and the potential seriousness of immunizable diseases. There was also poor social interaction between health workers and the mothers. It is recommended that emphasis be placed also on the social aspects of immunization if widespread coverage is to be achieved.

Attitude of Health Personnel↗
PubMedDate not supplied

Is permanent contraception acceptable in sub-Saharan Africa?

Some authors contend that the low use of family planning in sub-Saharan Africa is due to a low demand for fertility regulation among African men and women. The present authors' experience in Africa has been that it is not the demand for family planning services, but the way services are delivered that accounts for low numbers of acceptors in Africa. The specific case of Kenya is mentioned, where improvements in the quality of sterilization services and increases in the number of institutions that can provide minilaparotomy under local anesthesia have led to an increase in the acceptance of sterilization. The authors maintain that the demand for all family planning methods does exist, and it is up to the donor agencies and family planning service providers to try to meet that demand by providing services that are efficient to providers while oriented to the clients' needs. In the case of voluntary surgical contraception, that means providing minilaparotomy under local anesthesia.

Africa↗
PubMedDate not supplied

[Prenatal care in Latin America].

Available data on the coverage of prenatal care in Latin America were reviewed. In recent years, only Bolivia had a coverage of prenatal care of less than 50 per cent. More than 90 per cent of pregnant women received prenatal care in Chile, Cuba, the Dominican Republic, and Puerto Rico. Prenatal care increased between the 1970 and 1980 in the Dominican Republic, Ecuador, Guatemala, Honduras, Mexico, and Peru. The coverage of prenatal care decreased in Bolivia and Colombia. The mean number of visits increased in Cuba and Puerto Rico. The increase of prenatal care in Guatemala and Honduras is due to increased care by traditional birth attendants, compared to the role of health care institutions. We compared the more recent data on tetanus immunization of pregnant women to the more recent data on prenatal care. The rates of tetanus immunization are always lower than the rates of prenatal care attendance, except in Costa Rica. The rates of tetanus immunization was less than half as compared to the rates of prenatal care in Bolivia, Guatemala, and Peru. To improve the content of prenatal care should be an objective complementary to the increase of the number of attending women.

Female↗
PubMedDate not supplied

[Information systems for the management of local health systems].

Owing to the diffusion of computers--personal as well as highly sophisticated models--and of modern data bank systems and more accessible programming methods that no longer require hiring professional programmers to develop a variety of applications, administrators are increasingly using this new technology as a basis for making more realistic decisions. Good information systems are of great importance in the management of local health systems; however, in order for them to be truly useful, data collection must be homogeneous so that the data may be subsequently consolidated and compared. In this connection the authors present a model consisting of four stages: strategic planning; analysis of needs; allocation of resources; and selection of alternatives for consideration by project teams and suppliers of equipment and programs.

Delivery of Health Care↗
PubMed1990

The use of evaluation to improve the Expanded Programme on Immunization in Mozambique.

Reported are the results of an evaluation of process indicators and outputs for the Expanded Programme on Immunization (EPI) in Mozambique which were used to modify immunization strategies from 1985 to 1987. In 1986 according to cluster sample surveys, 84% of children in Maputo, the capital, were fully vaccinated. In other cities in the country, vaccination coverage increased from an average of 36% in 1985 to 55% in 1987. The major determinants of low vaccination coverage were provision of vaccination services at health centres on less than 3 days per week; missed opportunities; and vaccinating too early or with too short an interval between doses. The results of sentinel site surveillance in Maputo indicated that EPI had a marked impact on neonatal tetanus and to a lesser extent on poliomyelitis and measles. Evaluation led to changes in EPI policy in Mozambique (e.g., adoption of a uniform national vaccination schedule and discontinuation of the use of expired vaccine) and strategies (elaboration of different strategies for urban areas, rural areas, and displaced people). Also, performance was improved by involving programme managers and implementors in evaluation, and by providing timely and widespread feedback of results to policy-makers, peripheral health workers, and the community.

Child↗
PubMedDate not supplied

[The symptom-diagnosis interval: a possible approximation to the natural history of neoplasms].

In order to assess the influence that age, sex, site of the primary tumor (SPT), the extension and histology may have on the interval first symptom-diagnosis (ISD), 1.149 cases of lung, breast, stomach, colon and rectum cancer registered in the Tumor Registry of the Hospital del Mar (Barcelona) were analyzed. Overall, mean ISD was 5.7 months. 12.7% of women and 5.5% of men (p less than 0.0001) had an ISD greater than one year. Age does not appear to influence ISD in this population (r = 0.014). Among women, the ISD for each SPT was as follows: breast cancer, 9.1 months; rectal cancer, 6.5; stomach, 4.9; colon, 4.7; lung, 2.7. Men's ISD were: rectum, 6.2; stomach, 5.9; colon, 5.7; lung 3.2. Age, sex, SPT, the extension and histology jointly explain only 18% of the ISD variability (multiple r = 0.42 p less than 0.0001). SPT and histology appear to be the strongest predictors, both remaining statistically significant when adjusting for the other four factors. While only breast cancer clearly showed a positive association between ISD and tumor extension, an unexpected inverse relationship was observed in rectal cancer. In some tumors, the ISD may just be an indicator for the rate of tumor growth. ISD data registered in a Tumor Registry can contribute to the study of a part of the natural history of neoplasms. Such analyses are also relevant for studies of secondary prevention and screening programs, access to and quality of care, and psychosocial predictors of the care seeking process.

Adult↗
PubMedDate not supplied

Women's health: an alternative perspective for choosing interventions.

This paper outlines the health problems of mothers, discusses the links between maternal health and child health, and emphasizes the need to focus attention more clearly on the problems of women and the interventions that might help them as a way to improve both maternal and child health. The special problems of girls and women in the developing world--including maternity care, abortion, and maternal mortality and morbidity--and the ways in which these problems affect mothers and their children, are examined. Nutritional morbidity and infectious morbidity are described in terms of their effects on maternal and infant health, including low birth weight. It is shown how the cultural, social, and economic factors that affect women and children interact with their health problems. Recommendations are made to: reexamine well established interventions to determine if new program designs might improve long-term results; conduct research on the efficacy of retraining health personnel; broaden and improve service delivery; reassess the cost-effectiveness of highly targeted interventions; reexamine the locus of certain interventions; and emphasize long-term as well as short-term results. Attention should be given to women's health not only during pregnancy, but throughout the life cycle.

Adult↗