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PubMed2004

Ocular trauma in a rural south Indian population: the Aravind Comprehensive Eye Survey.

PURPOSE: To determine the rate of ocular trauma in a rural population of southern India and its impact on vision impairment and blindness. METHODS: A population-based cross-sectional study of 5150 persons 40 years or older in a randomly chosen rural population of 3 districts of southern India. Prospective information on trauma, type and agent of injury, setting of injury, and details of treatment sought for the last episode was recorded with questionnaires after face-to-face interviews. All interviewed subjects underwent a comprehensive ocular examination, including vision estimations, slit-lamp biomicroscopy examinations, and dilated posterior segment examinations. RESULTS: We elicited a history of ocular trauma in either eye from 229 (4.5%) persons, including 21 (0.4%) persons with bilateral ocular trauma. Blunt injuries (n = 124; 54.9%) were the major cause for trauma reported in this population. The most common setting where the ocular trauma occurred was during agricultural labor (n = 107; 46.9%). Nearly three quarters (n = 170; 74.2%) of those reporting ocular trauma sought treatment from an eye specialist (n = 104; 57.8%) and one fifth (n = 37; 20.6%) from a traditional healer. The age-adjusted (adjusted to the population estimates for India for the year 2000) prevalence for blindness in any eye caused by trauma was 0.8% (95% confidence interval [CI], 0.4-1.1). The odds ratios (OR) for trauma were higher for males (OR, 2.2; 95% CI, 1.6-3.0) and laborers (OR, 1.7; 95% CI, 1.2-2.4) and lower for literates (OR, 0.7; 95% CI, 0.5- 0.9). Seeking treatment from a traditional eye healer for trauma was not associated with vision impairment (OR, 1.0; 95% CI, 0.3-3.2) or with blindness (OR, 3.4; 95% CI, 0.2-56.5). CONCLUSIONS: Eye care programs may need to consider ocular trauma as a priority in this population, because the lifetime prevalence of ocular trauma is higher than that reported for glaucoma, age-related macular degeneration, or diabetic retinopathy from this population. Simple measures such as education regarding the use of protective eyewear could possibly significantly decrease this preventable cause of visual disability.

Adult↗

PubMed2005

Webcasting: a new instructional technology in distance graduate nursing education.

Webcasting is a new instructional technology used to deliver audio and video presentations via the Internet, enabling learners to participate in a live class via a personal computer. In this article, we describe the workflow involved in producing a Webcast class and provide a detailed account of the process of adopting Webcasting as a medium to provide distance education at a state university in a rural setting. This article addresses the team members required to seamlessly integrate Webcasting into the curriculum: information technology specialists, faculty, students, and administrators. We also identify problems encountered with implementation of Webcasting and methods used to resolve them.

Adult↗

PubMed1982

Occupational stress and illness incidence.

This study examined hospitalization rates for 10 stress-related illnesses among Navy occupational groups during four phases of a 30-year career and identified possible reasons for differences in health risks among occupations and career phases. Results of this longitudinal study, which covered 11 years and included an initial population of 184,122 male Navy enlisted Caucasians, showed that men assigned to Hospital Corpsman and Mess Management Specialist (culinary work) categories had the highest health risks for stress-related illness during nearly all phases or decades of a Navy career. Other groups with elevated hospitalization rates included Construction/Manufacturing, Deck, Ordnance, and Engineering/Hull, whereas the lowest rates were observed for Miscellaneous/Technical, Electronics, and Administrative/Clerical. The highest hospitalization rates for stress-related diseases were evidenced during the third decade. Job stress scores were computed from ratings of environmental characteristics, occupational stressors and career considerations; high scores on these dimensions tended to be associated with increased illness. Implications of these results for prevention programs are discussed.

Adult↗

PubMedDate not supplied

[Monitoring the pregnant diabetic patient].

Despite improved surveillance of pregnant diabetic women perinatal mortality and morbidity remains higher than in the general population. Low detection rates of patients with gestational diabetes represent one of the main reasons as screening programs based upon the presence of risk factors only comprise 30% of all women with gestational diabetes. Concerning maternal risks in patients with insulin-dependent diabetes mellitus the incidence of pregnancy induced hypertension is increased up to 12-28%. Macrosomia (6-32%) and malformations (1.5-6%) are the most frequent fetal complications and depend on the quality of controlling the blood glucose level. However, the decrease of fetal and maternal risks requires a general screening program for gestational diabetes as well as an intensive surveillance of the mother and the fetus by an obstetrician and internal specialist, respectively. Delivery of pregnant diabetic women should preferable be performed in specialized hospital units.

Combined Modality Therapy↗

PubMedDate not supplied

Chemical and biological terrorism preparedness for staff development specialists.

Staff development specialists must adapt orientation and continuing/life-long learning educational programs to provide nursing staff with the knowledge and skills required to respond to a biological or chemical terrorist attack. The integration of accurate, reliable, and timely information into staff development programs will contribute to the advancement of a national nursing workforce adequately prepared to respond to a major public health event resulting from the intentional use of biological and chemical weapons.

Antibiotic Prophylaxis↗

PubMedDate not supplied

From artisan to architect: the specialist and systems of provision of diabetes care in 2001.

OBJECTIVE: To discuss the future role of the diabetes specialist and the endocrinologist in the care of patients with diabetes. METHODS: We reviewed the literature on health care systems, integrated approaches to provision of health care, health care in the primary-care setting for patients with chronic illness, and population-based health care for patients with diabetes. RESULTS: Specialists who care for patients with diabetes will assume a more significant role as caretakers of teams of health care professionals who are responsible for the primary care of patients with diabetes. The integration of specialist care at the primary-care level may lead to improved outcomes at the primary-care level, increased access to specialty care, and decreased costs for the health care system. Alternative systems, such as regulatory barriers to specialist care, are less likely to accomplish these outcomes. CONCLUSION: In the near future, specialists will be expected to care for those who provide primary care for patients with diabetes. Endocrinologists and endocrinology training programs should recognize this emerging role and prepare for it.

Diabetes Mellitus↗

PubMed1988

The problem of grandmultiparity in current obstetric practice.

A retrospective analysis of 646 Arab grandmultiparas who booked for hospital confinement between 1983 and 1985 was carried out. The results were compared with that of non-grandmultiparas during the same period. In the grandmultiparas, the incidences of gestational diabetes, hypertension rheumatic heart disease, antepartum, postpartum hemorrhage and macrosomic infants were increased. However, contrary to some previous reports the incidences of anemia, cesarean sections, induced labor, dysmaturity and perinatal deaths were decreased. This is thought to be due to the provision of modern specialist perinatal care and improved socioeconomic standards.

Diabetes Mellitus↗

PubMed2000

[Health care in non-insulin dependent diabetics in lower Normandy].

To contribute to better quality health care for patients with type 2 diabetes mellitus living in the French Department Basse-Normandie, the Regional Union of General Practitioners (URML) and the Regional Union of the Nation Health Insurance (URCAM) studied ambulatory practices in this population in 1999. Eight hundred diabetics whose health care reimbursements suggested they were not followed by a specialized center were studied: 400 received a mailed questionnaire and for the 400 others, another questionnaire was filed out by the primary care physician. The physicians' responses demonstrated that they do not feel certain recommended complementary investigations are always necessary for following diabetic patients (microalbuminuria, glycated hemoglobin, search for neuropathy, ophthalmology consultation). Interaction with diabetologists, nutritionists and chiropodists was found to be insufficient. Globally, the responses of the diabetics was coherent with the physicians' statements, providing further precision concerning health care delivery and propositions for improvement. These results can be used to better target education programs for associations, specialists and general practitioners.

Adult↗

PubMed1996

A home visit program for CAPD.

In the U.K. in the last five years a reassessment of the central role of the hospital has taken place, with a fundamental shift in care for people with increased dependencies to community settings. For patients using peritoneal dialysis a need has been realized for a home-visiting service by specialist renal nurses who can manage and coordinate the program of care, thus reducing the strain on hospital resources. In addition, the provision of a community nurse to visit the patient at home means that ongoing education and training can be undertaken in a suitable learning environment. The home-visiting program creates an opportunity to develop an holistic care plan using strategies of general health promotion as well as practical nursing care. This paper highlights the experiences of a pioneering model of community continuous ambulatory peritoneal dialysis care in the South London. Auditing of this unusually funded post has shown significant reductions in peritonitis, exit-site infections, and hospital admissions in this growing patient population.

Community Health Nursing↗

PubMed2003

Barriers to the treatment of adolescent type 2 diabetes--a survey of provider perceptions.

OBJECTIVE: Type 2 diabetes mellitus (T2DM) is increasingly common among children and adolescents. However, achievement of good metabolic control has been difficult in this population. The aim of this study was to survey pediatric endocrine and diabetes specialists regarding the issues they consider to be barriers to successful treatment of adolescent T2DM. METHODS: An electronic questionnaire was administered to 220 physicians and nurses attending a conference on pediatric diabetology in 2001. RESULTS: The issues that were most strongly perceived as barriers to successful treatment of adolescents with T2DM were prevalence of high-risk lifestyle in other family members (98%), lack of immediate risk to life reducing patient motivation (89%), lack of guidelines regarding optimal treatment (73%), prevalence of behavioral and/or psychiatric disorders (71%), and cultural/language barriers (65%). The survey also revealed that in the majority of clinics, T2DM education programs were not designed specifically for type 2 patients nor delivered by a specifically trained education team. Furthermore, despite the fact that cultural and ethnic differences were identified as important barries to care, educational materials designed for particular racial and cultural groups were used in only 37% of the clinics. CONCLUSIONS: This survey identifies a number of areas perceived by clinicians to be significant barriers to successful treatment of T2DM in adolescent patients. Given the multiple challenges identified by the survey, programs addressed specifically to the characteristics of adolescents with T2DM will be necessary, including materials appropriate to the developmental stage and ethnic background of patients.

Adolescent↗

PubMed2002

Potential of specialist drug services to deliver hepatitis B vaccination.

The city of Glasgow has a large population of injecting drug users (IDUs) who are likely to be susceptible to acute hepatitis B infection. We evaluated the effectiveness of a hepatitis B vaccination programme delivered at three existing types of services for IDUs. It was found that while uptake rates were generally low, they were higher at services where throughput of patients was lower, where clients had continuing relationships with services and where staff training and confidence were better.

Adult↗

PubMed2004

Insurance policies and perceived quality of primary care among privately insured patients: do features of managed care widen the racial, ethnic, and language-based gaps?

CONTEXT: Little is known about whether some features of managed care widen disparities in patients' evaluations of primary care. OBJECTIVES: We investigated whether the magnitudes of racial and ethnic/language-based differences in patients' evaluations of the quality of primary care vary by capitation and gatekeeping. DESIGN: We used a telephone survey of a representative sample of the US noninstitutionalized population, Community Tracking Study Household Survey 1998-1999, and Followback Survey of respondents' insurance administrators. SETTING AND PARTICIPANTS: Our sample was privately insured adults who saw a physician at least once during the year preceding the interview and whose last visit was to a primary care physician. MAIN OUTCOME MEASURES: We measured patients' evaluations of (1) how well the physician listened, (2) how well the physician explained, and (3) how thorough and careful the physician was during the last visit. RESULTS: Significant white-minority differences emerge more often in plans using capitation or gatekeeping than in other plans. The gaps in patients' evaluations of their primary care providers' (PCP) explanations and thoroughness between whites and Hispanics interviewed in English are larger when the PCP is capitated than when the PCP is not capitated. The gap in the evaluations of their PCP's explanations by whites and Hispanics interviewed in English is larger in plans that require referrals for specialist visits than in other plans. The magnitude of racial and ethnic/language-based gaps for Hispanics interviewed in Spanish, blacks, and Native American/Asian/Pacific Islanders do not differ by capitation and gatekeeping. CONCLUSION: English-speaking Hispanics' perceptions of the quality of primary care may be more dissimilar from whites' when capitation or gatekeeping are used than when these policies are not used.

Adult↗

PubMed1999

A comparison study of access to health care under a Medicaid managed care program.

This article investigates the health care and insurance status of a low-income urban area in East Tennessee. The article reviews the background of TennCare, a compulsory Medicaid managed care program initiated in Tennessee in 1994. The study compared TennCare recipients with other insurance groups on key demographic and access variables. Possible explanations for how TennCare recipients rate their care also were examined. Qualitative analysis revealed accounts of long waiting periods, out-of-town specialist care, problems with obtaining pharmaceuticals, and general confusion about the new system. Implications of these findings for social work policy practitioners are discussed, and suggestions for alleviating the burden on patients are offered.

Adult↗

PubMed1997

Costs, outcomes, and patient satisfaction by provider type for patients with rheumatic and musculoskeletal conditions: a critical review of the literature and proposed methodologic standards.

PURPOSE: To compare the outcomes of care provided by generalists with that provided by specialists for patients with musculoskeletal and rheumatic conditions. DATA SOURCES: English-language studies published between 1986 and April 1996 were identified through a MEDLINE search. STUDY SELECTION: Studies that compared generalists' and specialists' treatment preferences, appropriateness of care, or outcomes with regard to musculoskeletal and rheumatic conditions were examined. DATA EXTRACTION: Studies were reviewed for methodologic rigor and outcomes. DATA SYNTHESIS: Low back pain is treated by many types of providers, without consistent differences in outcomes across provider types. In one study, however, patients were more satisfied with chiropractic care than with care provided by primary care physicians, although the former cost twice as much as the latter. For osteoarthritis of the hip, rheumatologists and primary care providers reported using different therapeutic regimens. For acute mono- and oligoarthritis, rheumatologists performed arthrocentesis more appropriately than nonrheumatologists and produced shorter durations of hospitalization. In the management of gout, rheumatologists used colchicine during the introduction of urate-lowering therapy more appropriately than other providers. In two population-based cohorts of patients with rheumatoid arthritis, patients cared for by rheumatologists were prescribed significantly more disease-modifying agents and had less disability than patients cared for by generalists. CONCLUSIONS: Although empirical data are scant, there seem to be differences between generalists and specialists for a range of outcomes in various musculoskeletal and rheumatic conditions. Studies to data have important methodologic limitations that need to be addressed in future research.

Health Care Costs↗

PubMedDate not supplied

[Surveillance of the clinical course of 6,030 surgical wounds].

This report describes a 4 year prospective study of postoperative wound infections, utilizing a program of wound surveillance. Surgical wounds after 6030 operations of a general surgery service were surveyed by the authors and a specialist nurse, daily and in the follow up clinic for 30 days. Results were reported to all the surgeons monthly. The rates of infections demonstrated a decline over the years of surveillance. In the first year there was a 6.37 percent incidence of infection and the fourth year 4.7 percent. This represents an improvement in hospitalization days and expenses.

Humans↗

PubMed1989

Lower-extremity amputation in people with diabetes. Epidemiology and prevention.

The age-adjusted rate of lower-extremity amputation (LEA) in the diabetic population is approximately 15 times that of the nondiabetic population. Over 50,000 LEAs were performed on individuals with diabetes in the United States in 1985. Among individuals with diabetes, peripheral neuropathy and peripheral vascular disease (PVD) are major predisposing factors for LEA. Lack of adequate foot care and infection are additional risk factors. Several large clinical centers have experienced a 44-85% reduction in the rate of amputations among individuals with diabetes after the implementation of improved foot-care programs. Programs to reduce amputations among people with diabetes in primary-care settings should identify those at high risk; clinically evaluate individuals to determine specific risk status; ensure appropriate preventive therapy, treatment for foot problems, and follow-up; provide patient education; and, when necessary, refer patients to specialists, including health-care professionals for diagnostic and therapeutic interventions and shoe fitters for proper footwear. Programs should monitor and evaluate their activities and outcomes. Many issues related to the etiology and prevention of LEAs require further research.

Aged↗

PubMedDate not supplied

[A model for integrating mental health care resources in the rural population of Mexico].

OBJECTIVE: The purpose of this project was to identify behaviors of health service utilization to solve mental health-related problems among rural inhabitants of Mexico. A model of pathways to mental health services was built. Based on this model, an integration-intervention model is proposed to help improve access to mental health services and their quality. MATERIAL AND METHODS: In 1997, in-depth interviews were conducted among 21 adults (9 men and 12 women) and seven healthcare providers, in a rural community in Jalisco, Mexico. Women's age ranged from 23 to 44 years; ten were married and two single. Men were between 30 and 74 years old; eight were married and one was a widower. Healthcare providers in the same community were: a priest, a general physician, a pharmacy clerk, two nurses, and two traditional healers. RESULTS: The pathways models suggest that the first attempt a person does to solve a symptom is self-care. When such strategies are not sufficient to relief the symptom, the person turns to the members of his/her social network for help, who in addition to providing information about remedies, offer their emotional and instrumental support. If after consulting the social network, the symptom is not relieved, the individual seeks help from other external resources, such as the members of the ethnomedical local system. Inhabitants of rural communities tend to seek help from physicians, only when the symptom persists and the suffering associated with it seems to be out of the individual's control, or if members of the social network or the ethno-medical local system refer the patient to the physician. Seeking help from a specialist in mental health (psychiatrist or psychologist) is quite improbable among the rural inhabitants of Mexico, mostly due to difficulties in accessing these services, such as geographical location, distance, transportation, cost, and cultural distance between the health providers and the patient. CONCLUSIONS: In order to conduct successful intervention programs that are culturally sensitive for rural inhabitants, it is necessary first, to have detailed information derived from research and second, the active participation of all human and institutional resources, from professionals and truly multi-disciplinary researchers, to educators, social, religious, political leaders, and members of the communities and local institutions. The proposed model of integration of personal and community resources for healthcare requires establishing programs that sensitize, inform, and train community members, as well as members the ethno-medical system and the formal heath system.

Adult↗

PubMed2004

Why it is time to review the role of private health insurance in Australia.

The role of private health insurance (PHI) within the Australian health-care system is urgently in need of comprehensive review. Two decades of universal health cover under Medicare have meant a change in the function of PHI, which is not reflected in policies to support PHI nor in the public debate around PHI. There is increasing evidence that the series of policy adjustments introduced to support PHI have served to undermine rather than promote the efficiency and equity of Australia's health care system. While support for PHI has been justified to 'take pressure off the public hospital system' and to facilitate choice of insurer and private provider', and the incentives have indeed increased PHI membership, this increase comes at a high cost relative to benefits achieved. The redirection of hospital admissions from the public to private hospitals is small, with a value considerably less than 25% of the cost of the policies. The Commonwealth share of the health care budget has increased and the relative contribution from private health insurance is lower in 2001-02, despite an increase in PHI membership to nearly 45% of the population, compared with the 30% coverage in 1998. The policies have largely directed subsidies to those on higher incomes who are more likely to take out PHI, and to private insurance companies, private hospitals and medical specialists. Ad hoc policy adjustments need to be replaced by a coherent policy towards PHI, one that recognises the fundamental change in its role and significance in the context of universal health coverage.

Australia↗