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At least 271 records · Page 15Linked to original sources

PubMed1985

Community-based team approach to the management of children with cleft palate.

The child born with a cleft palate may have many associated problems in feeding, respiration, dentition, hearing, speech, language, and intellectual development as well as in psycho-social development. If the cleft is associated with a specific craniofacial syndrome, other physical problems may be present such as cardiac, kidney, digital, and visual involvement. The need for an extensive treatment program can extend from birth through adulthood. Important to the successful habilitation of these children is the early involvement of a multitude of specialists working together with the family in a team approach. The primary task of the team is to make decisions concerning timing and sequence of intervention for each individual patient. Several models for the delivery of health care services to the patient with a cleft palate are now in use. A community-based team model will be described in this article as a unique approach to the management of this population and as one that may be implemented in a cost-effective manner in communities where cleft palate teams presently do not exist.

Child↗

PubMed1977

[Methodology of a long-term study of senile dementia].

The longitudinal method aims to point out phenomena that are bound with time. It is thus particularly fit for the study of ageing as it is proved by many large American research programs. It is also useful to follow during a limited period (short term) the natural history of pathologic entities as degenerative illnesses. After mentioning the fundamental conditions of any longitudinal approach, the program of this study on senile dementia is described. Each case is followed for 2 years, with an examination every 6 months. This later is based on anamnestic, psychiatric, neurologic and functional items as well as on intellectual functions and EEG. A sample of 50 cases should be collected. After a period of 3 years prospection 91 cases were found of which on 31 fitted. The difficulty of recruitement is bound to several factors: the little knowledge of senile dementia frequency in the general population, the poor criteria used in their choices by non-specialists as the directors of homes, the refusals and the withdrawals. Difficulties in establishing contact with patients showing behavioral troubles are underlined as well as cooperative problems with the surroundings. The repetition, at regular periods, of psychological tests sets the problem of learning. In the way of senile dementia it should decrease with the illness evolution thus bringing the overestimation of initial capacities, the gap becomming artifically greater between performances at the beginning and at the end of the observation.

Age Factors↗

PubMed1990

[Smoking behavior of medical students, house officers and specialists in Groningen, 1989].

Smoking habits and attitudes towards smoking of medical students (n = 725), house officers (n = 126) and consultants (n = 236) of the University Hospital of Groningen were studied in 1989 using a WHO questionnaire. Overall response was 84%. Twenty-seven percent of the medical students, 28% of the house officers and 34% of the consultants are current smokers. The prevalence of smoking in medical students and house officers is lower than that in the Dutch population. Smoking habits of consultants are similar to the general population. The prevalence of smoking Dutch physicians which was 56% in 1983 is decreasing rapidly. Doctors report they want more information about smoking cessation programs.

Adult↗

PubMed2004

[Medical care requested by smokers and at-risk alcohol consumers: results of a representative population survey].

PURPOSE OF THE STUDY: Due to difficult availability of subjects with substance-related disorders (especially nicotine and alcohol) via the existing specialised treatment services, the impact of proactive early interventions in hospitals and general practitioners is increasingly acknowledged. Only little is known as to known many persons with substance-related disorders are not attainable via this pathway and where such persons could be contacted. In the present study, we analysed the prevalence of substance-related disorders and the motivation to change in subjects drawn from a representative population survey with and without use of medical services during the preceding year. METHOD: The present analysis is based on data from the TACOS ("Transitions in Alcohol Consumption and Smoking") Study (N = 4075) conducted in the town of Luebeck and its environs in Northern Germany. Utilisation of medical services was differentiated in non-utilization (NI), hospital admission during the previous year (KH), at least one visit to a general practitioner (HA), specialist only (FA) and dentist only (ZA). RESULTS: 75% of the population had been to a hospital or their general practitioner in the previous year, a further 18.3% visited a specialist or a dentist only and 4.8% did not contact medical services. Analysis revealed a higher prevalence of smoking and increasing alcohol consumption combined with a higher unemployment rate in NI, followed by KH, HA, FA and ZA. CONCLUSION: The majority of smokers and subjects with at-risk alcohol consumption can be attained via medical services. Additionally, early interventions in dentist practices and employment offices might include further substantial groups of smokers and at-risk drinkers.

Adolescent↗

PubMed1993

Hearing impairment: is it a public health problem among primary school pupils in Alexandria?

A hearing screening survey was conducted among the primary school students in Alexandria. It aimed at measuring the prevalence of hearing impairment among students and studying the predisposing factors of hearing problems. The schools of the middle educational region were selected to carry out the study. Hearing tests; audiometry and tympanometry, were used to screen 196 students from different types of schools (113, 55 and 28 students from governmental, language and private schools respectively). A questionnaire was introduced to a subsample of those students (n = 141) including some predisposing factors of hearing problems and answered by parents. The physical environment of schools was studied including noise level, ventilation and crowding. The obtained results showed that the prevalence of failed students in audiometry and tympanometry was 24.49 % and 36.22 % respectively. Moreover, the prevalence of pupils who failed in both tests was 7.65 %. Boys were more likely to have hearing impairments than girls. Positive family history of deafness early in life and the continuous complaining of nasal obstruction were significantly related to hearing impairments among students. A very small percentage of parents (4.17 %) were aware of the presence of a hearing problem in their children. Furthermore, 48 % of failed students in audiometry were poor achievers in schools as stated by their teachers. The study of physical environment in schools revealed noise levels (inside and outside classes) above the acceptable but still within the permissible level. On the other hand, crowding at schools, as measured by the per capita space area, showed a significant association with the hearing problems in students. It is recommended to improve awareness of parents and teachers through health education programs. Screening questionnaire can develop an at risk concept for children, as the use of specialist otologists for screening is likely to be very expensive and they must be considered as first point of referral after screening.

Acoustic Impedance Tests↗

PubMedDate not supplied

[Handicaps due to perinatal causes in Trento newborn infants (1979-1988)].

A survey on perinatal handicaps must follow some standards: a) homogeneous population; b) univoc method of evaluation; c) 7 years follow-up; d) case control study. From ethnic and geographical point of view, Trentino is in a favorable condition; all pathologic cases come in the only 3th Level Center (Trento), and all neurological evaluations were made from the same specialist up to primary school. Now case control survey is starting. In district of Trento neonates without congenital malformations have risk for severe residual handicaps of 0.08%; under 1500 g the risk is 6.5% while in the group 1500-2499 the risk is 0.53%. A better prevention program during pregnancy and in Intensive Care Unity may reduce the severe outcome in the 1500-2499 group of neonates.

Birth Injuries↗

PubMed1984

Comprehensive management of children with muscular disorders.

As can be determined from a review of three of the most common diseases seen in a muscle disease clinic, the care cannot be given by only one or two specialists. The treatment programs involve a team. The team members have specific skills and functions. On the other hand, a team that works together can anticipate problems that other members of the team are most capable of handling. Early recognition of problems will minimize the difficulties that the patients will invariably encounter. The goal of the comprehensive management is to make the patient as self-sufficient as possible, for as long as possible, both physically and vocationally. This, obviously, is extremely helpful psychologically, both for the patient and the patient's family. Working with this population of patients, although occasionally depressing because of the inability to cure, can be extremely rewarding as one watches the accomplishments of the patients as a result of the interventions discussed.

Child↗

PubMed2004

Preferences for arthritis care among urban African Americans: "I don't want to be cut".

Despite greater disability from knee osteoarthritis among Blacks, Whites are 3-5 times more likely to have total knee replacement (TKR). The authors explored whether beliefs among Blacks about arthritis and surgery contribute to this disparity. Ninety-four Blacks, ages 50 to 89, with knee arthritis underwent semistructured qualitative interviews regarding disability, beliefs about arthritis, beliefs about TKR, and treatment preferences. Content analyses yielded 6 themes: preference for natural remedies, negative expectations of surgery, beliefs about God's control, preference for continuing in their current state, relationships with specialists, and fear of surgery or death. Given its high levels of disability, this cohort had low expectations of TKR. Culturally sensitive educational programs might improve patient altitudes and beliefs regarding TKR, ultimately increasing appropriate usage.

Black or African American↗

PubMed1996

An integrated care system for musculoskeletal disorders in a managed care setting.

Practice guidelines, education, consensus building, and extensive communication were the tools used in developing a musculoskeletal care system. Primary care physicians directed patient care using practice guidelines for common musculoskeletal conditions. Patient education and empowerment were emphasized. Specialist consultations were made available by telephone/voicemail to advise primary care physicians regarding treatment plans and the need for specialty referrals. Significant reductions in medical service utilization for this patient population were achieved while high levels of patient satisfaction were maintained. Such integrated systems are likely to work well within other MCOs.

Case Management↗

PubMed2006

Current asthma guidelines may not identify young children who have experienced significant morbidity.

BACKGROUND: The current guideline for classifying asthma severity, the National Asthma Education Prevention Program (NAEPP) 2002, is not evidence-based. We had the opportunity to validate this guideline in an untreated inner-city population, both in those < or =5 and those >5 years of age. The basis for this retrospective validation model was to determine how well the NAEPP severity classification based on symptom-frequency criteria alone identified patients in those age groups demonstrating significant morbidity the previous year and thus the potential need for controller therapy. METHODS: Using a mobile asthma van (Breathmobile) at the school site, children not receiving controller medication were evaluated by an asthma specialist for severity according to NAEPP guideline clinical criteria. Validation was determined by the relationship of guideline severity to > or =2 emergency department (ED) visits, any hospitalization, health care utilization (any ED visit, hospitalization), number of exacerbations, and school absenteeism resulting from asthma the prior year. RESULTS: Eight hundred twenty-six asthmatic children were evaluated; 89 (10.8%) were < or =2 years, 222 (26.9%) were 3 to 5 years, and 515 (62.3%) were >5 years of age; 60.5% were male, and 80.9% were Hispanic. Classification of asthma severity included 34.4% with mild intermittent, 10.2% with mild persistent, 31.5% with moderate persistent, and 24.0% with severe persistent asthma categories. There were significantly more Hispanic children and children < or =5 years classified as having mild intermittant asthma. Morbidity was clearly related to severity in the overall population. However, although the health care utilization was significantly related to severity, it was borderline in those 3 to 5 years and nonsignificant in children < or =2 years. CONCLUSIONS: The NAEPP guidelines 2002, based on symptom-frequency criteria as assessed in this study, seem to offer a valid basis for classifying asthma severity in those >5 years of age but may underclassify younger children. Our data suggest that morbidity experienced in the prior year may provide a useful additional criterion for classifying asthma severity, particularly in those children < or =5 years of age.

Asthma↗

PubMed1996

[Urology specialization. Part III. Opinion of resident internal physicians].

At present the only official way for the training and obtention of a degree of specialist in Urology is through the Resident In-house Physician (MIR) program. With the passing of time both the rights and the wrongs of the training program under consideration come to light. From the former we try to obtain the maximum yield and with the latter we attempt to improve them or withdraw them if obsolete. The purpose of this survey was to evaluate from the Urology resident in-house physicians point of view, their training term. To that end, we have chosen the MIR examination of groups for the years between 1988 and 1992, both inclusive, a population that amounts to 252 subjects. There has been three releases of the questionnaire to all Teaching Hospitals within the national geography but only 81 (32.1%) resident physicians have answered it. The extensive questionnaire was divided in 6 sections: demographics, personal evaluation of the hospital staff and service, health care activities (admittance schedule, out-patient surgery, operating theatre and emergencies), non-health care activities (publications, attendance to congresses, etc...), evaluation of the MIR system, and professional aspirations.

Internship and Residency↗

PubMedDate not supplied

[Meningococcal C disease epidemic in Galicia 1996: the decision making process].

In this article we describe the decision making process used to choose the best alternative for bringing under control an epidemic of meningococcal C disease, which occurred in Galicia in 1996. In the decision making process, we used a methodology which consisted on the identification and definition of a problem, in order to identify alternative solutions and to select one, and finally implement and evaluate it. The health problem was detected studying the data obtained from a survey conducted following an outbreak of meningococcal C disease in february 1995 and from the active epidemiological surveillance system created thereafter. Because this was a new, complex and severe problem, with far-reaching social consequences, critical for our organization, and with long-term implications, and because it was considered important to take the decision as objectively as possible and to clearly explain it, the methodology chosen to solve the problem was a non-programmed, multicriteria making decision process, carried out by a working group using a criterion weighting approach. This working group was created within the General Directorate of Public Health, composed of specialist and of people responsible for the different areas involved. The working group put into practice the different steps of the methodology. The assessment criteria and their respective weights were: effect (efficacy measured by the number of cases we could have prevented if the alternatives were applied in the previous season) 40%; cost (in millions of pesetas) 15%; acceptability (acceptance of and response to each strategy from different groups: general population, health care professionals, other Administrations with competency in Public Health) 30%; and coherence (adherence to the currently accepted strategies for disease control in other countries)15%. When these criteria were applied to the ten alternatives considered, a score was obtained for each one of them. The highest scoring alternative corresponded to the massive vaccination of the total population of Galicia between 18 months and 19 years of age.

Adolescent↗

PubMedDate not supplied

[Mid-term evaluation of a provincial program of diabetes].

The following were analysed with the object of evaluating a provincial diabetes programme (Institut Català de la Salut. Tarragona Management Areas): a) training activities for professionals in primary health care, and b) some indicators of effectiveness. Between 1987 and 1989, 192 professionals of the institution (89 doctors [46.3%], 85 nursing specialists [44.2%], and 18 members of other health care areas [9.5%]) took part in 8 basic courses on diabetes and diabetological education. A subjective (opinion questionnaires) and objective (written tests) increase in theoretic knowledge was recorded. Continuous counselling from the programme has encouraged the development of 11 initiatives in aiding diabetics (both care and education), in centres in 7 regions in the province of Tarragona, which are presently offered to a reference population of 188,000 inhabitants (30-35% of all users). A provincial census has been started up, with data at present on 2,052 diabetics (189, or 9.3%, type I and 1,863, or 90.7%, type II). A strong increase was recorded in provincial dispensing of insulins by pharmacies (50% higher than in 1985), as well as of material for glucoketonuric and glycemic self-analysis (7-8 times higher than in 1985). Requests for glycosylated hemoglobin from the primary sector rose from 53 in 1986 to 634 over the first six months of 1989. The programme has contributed to enhance the quality of primary aid to diabetics in our regions.

Diabetes Mellitus↗

PubMed1997

Generalizability of the surveillance, epidemiology, and end results registry population: factors relevant to epidemiologic and health care research.

To assess the generalizability of the population included in the Surveillance, Epidemiology, and End Results (SEER) tumor registries to the overall United States population, we compared the population of the 198 SEER counties to the population of the 2882 non-SEER counties regarding sociodemographic factors, physician availability, and availability of pertinent hospital resources. The population residing within the SEER areas is more affluent, has lower unemployment, and is substantially more urban than the remainder of the U.S. population (p < 0.001 for each). The SEER areas have fewer general and family practice physicians, but more total nonfederal physicians, general internists, and specialists relevant to cancer care. SEER areas have fewer Joint Commission on Accreditation of Hospitals accredited hospitals, hospital beds, and hospitals with CT scanners, but more hospitals with bone marrow transplantation. The differences between the SEER population and the remainder of the United States, especially SEER's higher socioeconomic status and more urban population, should be considered when generalizing from SEER to the entire country.

Health Services Research↗

PubMed1998

The Mayo Vascular Center experience.

American medicine is trending toward an increasing number of specialty care centers. Cancer centers, transplant centers, and sports medicine centers are only a few common examples. Vascular centers are relatively new entities that are forming for obvious reasons. As the general population ages, peripheral vascular disease has become more prevalent. Several types of medical, surgical, and radiological specialists are involved in the diagnosis and treatment of such patients. Creating multispecialty vascular centers is one method to focus expert care on the patient, to alleviate some of the turf battles between specialties, and to contain burgeoning Medicare costs.

Hospitals, Group Practice↗

PubMed2000

Postgraduate medical education for rural family practice in Canada.

Canada is a large country with a diverse and spread-out rural population. Compared to their urban counterparts, rural Canadians have fewer family doctors and dramatically fewer specialists, and they face other significant geographic barriers to accessing health care. This paper describes the milieu of the rural physician in Canada and reports on efforts to develop a postgraduate medical education model for rural family practice that will produce more physicians with the knowledge, skills and interest to practice in small and mid-sized communities. Key recommendations of the College of Family Physicians of Canada include: providing earlier and more extensive rural medicine experience for all undergraduate medical students, developing rural postgraduate training programs, providing third-year optional special and advanced rural family medicine skills training and making advanced family medicine skills training competency-based and nationally accredited.

Canada↗

PubMed1999

New intervention strategies for reducing antibiotic resistance.

Rising antibiotic resistance rates among bacterial pathogens have resulted in increased morbidity and mortality from nosocomial infections. Widespread use of certain antibiotics, particularly third-generation cephalosporins, has been shown to foster development of generalized beta-lactam resistance in previously susceptible bacterial populations. Reduction in the use of these agents (as well as imipenem and vancomycin) and concomitant increases in the use of extended-spectrum penicillins and combination therapy with aminoglycosides have been shown to restore bacterial susceptibility. Studies have shown that education-based methods, as opposed to coercive measures, are effective in changing the prescribing habits of physicians. Cooperative interaction among infectious-disease physicians, clinical pharmacists, microbiology-laboratory personnel, and infection-control specialists is essential to provide useful suggestions regarding antibiotic choice and dosing to the prescribing physician in real time. Several hospitals have implemented antimicrobial resistance management programs based on these findings. The results of these programs validate the use of a multidisciplinary, education-based, antibiotic-resistance management approach.

Anti-Bacterial Agents↗

PubMedDate not supplied

Barriers to the physician decision to offer hospice as an option for terminal care.

Hospice is one care alternative available to the terminally ill, but if physicians do not offer this option, it is not likely to be considered by a patient who is making end-of-life decisions. A 15-item questionnaire to determine which barriers hinder or delay a physician's decision to discuss hospice with patients was sent to 147 physicians in one area of western Wisconsin. The study population included primary care physicians (family practitioners, internists and pediatricians) and specialists (cardiologists, gastroenterologists, nephrologists, neurologists, oncologists, pulmonologists, radiation oncologists, and urologists). The barriers receiving the most citations were: "patient or family hasn't accepted the terminal diagnosis," "patient or family desires to continue life-prolonging treatment," "patient has no family or friends to help hospice provide care," and "difficult to prognosticate amount of time patient has to live." Personal interviews with 13 of the participating physicians revealed additional barriers: "concern over loss of involvement with patient," "admitting patient to hospice causes some inconvenience," "deficit in physician knowledge of local hospice program," "introduction of hospice late in course of illness," and "use of home health services instead of hospice." Knowledge of these barriers may lead to an interdisciplinary approach to ensure that patients receive information of all alternatives available for terminal care.

Adult↗