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PubMed1999

[Work and professional position of medical specialists trained at the Hospital Clinic of Barcelona].

BACKGROUND: To analyze the working and professional position of medical specialists trained at the Hospital Clínic of Barcelona (Spain) during the last years, and to inquiry about their opinion on both the quality of the training that they received and the ways to improve it. POPULATION AND METHODS: Self-administered questionnaire of closed questions send to 402 specialists that finished their residency at our hospital from 1988 to 1996. RESULTS: 128 completed questionnaires were received and analyzed. The median age in this sample was 34 years (range, 29,41, and 58% were males. 94% of those polled are engaged in medical practice as specialists, 76% have a full-time job. 55% of the specialists complement this main job with others, mainly in private practice. The 40% have been sometimes unemployed, and, for half the specialists, more than one year elapsed from the end of residency to the first full-time job. 97% of those polled ranked the quality of the residency training as good, but most of them emphasized the need for more general knowledge and skills, in addition to the specialized training. CONCLUSION: Most medical specialists trained during the last several years have attained what seems to be an stable working and professional position. The scope of the specialists' training programs by must be broaden including more general knowledge and skills.

Adult↗

PubMed1980

A perspective on forage production in Canada.

Over the past decade, the cattle industry has experienced practically a full circle. With the promising beef prices in the early 1970s, with the glut of grain and a generous assist from government incentive programs, the forage acreage and cattle population have increased at a record rate. By 1974, the tide began to turn - grain prices went up sharply and beef prices became sluggish - and by 1976 a major crisis faced the producers. The cattle industry which had been developing on a cheap grain economy was now obliged to rely more on forage for its survival. Unfortunately, the forage was not existent and the only salvation of the industry was the gift of Providence - weather patterns that provided ample moisture conditions and above normal forage crops, the utilization of cereals and the intervention of government cow-calf support programs. Over the past year, the cycle was completed and record beef prices again prevail. The barley bins are full again and the cattlemen are gearing up for a few fat years. Demands for forage seed are brisk and the seeding down of forage acreage is bound to increase substantially over the next few years. And with this increase, cattle population expansion is bound to follow: how much expansion can the economy support? The production cost factors will determine the extent, but one can almost be certain that any expansion will either be modest or of short duration. At least, it should be. If the cattle industry is to establish solid foundations, it cannot be dependent upon the instability of a grain surplus-shortage position. With the present resources and the potential for developing it in direct competition with other crops, one can only expect a small and steady expansion over a long time span. One must agree with the range researchers and specialists of the Canada Research Stations at Lethbridge and Swift Current that pasture and range will continue to be the limiting factors of cattle expansion as they have been for the past 50 years. It is interesting to note that in the Prairie Provinces at least, the number of livestock raised each year has not changed since 1930 although cattle have largely replaced the horses. It is easy to speculate on paper that Canada can double in the next 20 years its forage and cattle production on its large expanses of land on the fringes of the agriculturally settled areas. It is true that these lands, while marginal for cash crops, could produce excellent forage. But at what cost? And what kind of pasture could we grow on them?It is easy to speculate that our livestock geneticists can breed a ruminant-type animal that will feed on poplar saplings and poplar leaves, or develop a new breed of cattle with buffalo vigor that will thrive in the extreme north. But looking at the musk-ox experience in the Northwest Territories and the history of the Wood Buffalo National Park leaves little room for optimism. The present generation is not likely to see in its lifetime the cattle population go beyond the 20 million mark. We can look, however, with good assurance on the present cattle numbers remaining stable and can look forward to gradual increase brought about by normal improvement in both forage and cattle management.Hopefully, both the cattle producer and the veterinarian will be able to reap the benefits of this most important segment of Canada's agricultural industry.

Animal Feed↗

PubMed1998

Introducing an integrated imaging delivery system in Manitoba.

OBJECTIVE: As a result of the reform of a comprehensive government health plan, an integrated imaging system is being created in the province of Manitoba. The intent of the system is to reduce costs, avoid causing harm to patients, enhance physician referral services and add new programs. METHODS: Evaluation of trends in examinations, equipment, personnel, expenditures and policy in the 1992-93 and 1995-96 fiscal years in Manitoba. RESULTS: The population has remained steady, at 1.1 million. Hospitals have been amalgamated under new authorities, and Manitoba's annual health care spending of $1.8 billion has been reduced by $235 million. Between the 2 years, use of radiography declined from 835,748 to 726,394 examinations per year. Use of mammography, ultrasonography, computed tomography, magnetic resonance imaging and nuclear medicine increased moderately. The total number of radiologic examinations declined from 1,069,579 to 975,044. There was little change in equipment, but the plant aged as a result of freezes on construction and capital spending. Personnel declined by 20 full-time equivalent positions, from 794.3 in 1992-93 to 774.3 in 1995-96. Savings in operations were made as a result of hospital budget restrictions. Total expenditures declined from $100 million to $89 million. The income of imaging specialists did not change because they were paid higher fees for examinations involving newer technology. CONCLUSION: Integration of rural/northern and urban hospital services has followed the plan set out in recent legislation. Savings of up to 20% are expected to be realized through reduction in personnel (saving $1 million), group tendering ($1 million), in-house repair ($1 million), reduction in deployment of equipment ($3 million), integration of services ($1 million), indirect cost reduction ($5 million), practice guidelines ($3.5 million), reduced breast screening costs ($1 million), physician payment reform ($1 million) and rigorous clinical/fiscal audit ($1 million).

Cost Savings↗

PubMed1989

Strategies for developing innovative programs in international medical education. Identification of educational needs.

A U.S. medical educator noted that the needs of developing countries are not necessarily addressed by traditional methods of medical education in the United States, involving high-technology education, technology transfer, development of academic personnel, and the like. In many developing nations, where there may be a surplus of doctors and many unemployed doctors, there is also a vast population of underserved people. Many of the physicians may have been trained inappropriately, or they were not comfortable in certain environments. In order to have an impact on the vast population, that kind of anachronism must be addressed. He inquired whether there is a role for the United States in addressing the health of communities rather than the sickness of individuals. It was observed that the health needs of developing countries are often thought to relate to the issues of hygiene, sanitation, and prevention and that these needs are homogeneous. The needs for interventional technology and preventive primary care should be differentiated, and the requirements at both levels of assistance should be heeded, be it at a primary and preventive level or at the level of specialist-oriented technological intervention. There was discussion about the dichotomy that exists between schools of public health in the United States and the medical schools with which they are associated. They were referred to as "two separate cultures." Thus, some suggested that U.S. physicians involved in curative medicine need to be exposed to community-based medicine in other countries, and many questioned whether other countries should seek to model their systems after those in the United States.(ABSTRACT TRUNCATED AT 250 WORDS)

Allied Health Personnel↗

PubMed2000

[Regional survey of Pays-de-la-Loire on the quality of sonography in the first trimester of pregnancy].

The aim of this investigation carried out by the Medical Insurance team of the five counties of the Pays-de-la-Loire region was to evaluate the quality of first trimester sonographies from the medical reports of all patients whose pregnancies began between the 1(st) and 31(st) of October 1997. Two populations could be distinguished: one of 252 women who were refunded after a first trimester ultrasonic examination and another of 111 patients for whom this exploration was not recorded. Communication of the sonographic protocol was obtained in 80% of cases. According to the established applications of the literature and to the recommendations of the French Club of Fetal Sonographers, these reports could then be classified as complete (31.2%), incomplete (31.6%) or unsatisfactory (37.2%). This regional investigation outlines the obsolete nature of the nomenclature of medical procedures and the need for a better initial and continuous education of French sonographists, considering the fixed practice of so many specialists in Obstetrics and Radiology.

Adult↗

PubMed2006

The effects of expanded mental health benefits on treatment costs.

BACKGROUND: Mental health disorders represent one of the most common problems facing adults in the labor force. It is estimated that within a 12-month period nearly 30% of the US population experiences some diagnosable mental health or addictive disorder. This study examines the impact that corporate benefit policies can have on mental health treatment costs. AIMS: To measure the effects of a change in mental health benefit design on treatment expenditures for employees of a large US-based company. METHODS: Data came from mental health treatment administrative claims and eligibility information provided by the company and a comparable set of claims for a randomly selected control group for the years 1995-1998. We measure the effect of a change in mental health benefits consisting of three major elements: a company-wide effort to destigmatize mental illness; reduced cost-sharing for mental health treatment; and the implementation of a provider network that emphasized access to non-physician mental health specialists. We use a two-part regression model within a difference in differences framework to examine outpatient, pharmaceutical, and combined outpatient and pharmaceutical expenditures between the treatment company and the control group. RESULTS: We find that the program led to a statistically significant dollar 17 increase in outpatient costs (excluding pharmaceutical costs) per employee. Similar to outpatient care we find that the benefit change was associated with a statistically significant increase in pharmaceutical costs of about dollar 15. DISCUSSION: The results reveal that the mental health benefit expansion at the company led to a significant increase in aggregate mental health expenditures among employees. However, the aggregate increase in cost masks a number of interesting underlying trends in mental health utilization. First, conditional upon any mental health treatment, mental health costs were virtually unchanged before and after the benefit change. Conditional on any use, outpatient and pharmaceutical expenditures went in opposite directions, with outpatient expenditures falling and pharmaceutical expenditures increasing. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Private sector initiatives can increase use of mental health care treatment through decreased cost-sharing, improved access to specialty providers, and destigmatization of mental disorders. IMPLICATIONS FOR HEALTH CARE POLICY FORMULATION: Given that the vast majority of people in the US get their health insurance through employer-sponsored health insurance, efforts on the part of the private sector to recognize and treat serious chronic illnesses such as mental disorder in a proactive manner should be encouraged. IMPLICATIONS FOR FUTURE RESEARCH: While the aggregate cost of corporate initiatives to improve access to quality mental health care is frequently examined, it is also important to decompose the aggregate cost changes into effects from a change in the rate of initiation and changes in utilization conditional upon initiation.

Adolescent↗

PubMed1996

Managed care, accountability, and the physician.

The 1990s is truly the era of increased accountability in the practice of medicine. Through the methods of cost and quality measurement and the introduction of a manager (i.e., the MCO), society as a whole will benefit from a medical delivery system that focuses on linking the outcomes of care delivered to the processes of the care provided. Report cards serve an important tool by which information about quality and costs can be quantified and shared with the purchasers and users of the medical delivery system. Purchasers and patients are asking for greater accountability from payers and providers. The increased accountability of physicians to health plans, IDSs, hospitals, and patients with whom they interact has major implications on the definition of success in the managed medical delivery system of today. The theme of accountability has been described by the examples of the HEDIS Quality Report Card for health plans and Quality Report Cards for hospitals, PCPs, and specialists. Physicians must provide high-quality care to each patient they see but must also develop the mindset and structures to manage an entire population of patients. The expectations of each of the entities with whom they interact must be understood, and physicians need to develop the skills and infrastructure to put total quality management and information technology to work to help them facilitate the delivery of high-quality care in a cost-effective manner. Everyone involved in the health care system--from purchasers to payers to consumers--shares the same goals as physicians: provide the highest-quality care and achieve the best possible outcomes in the most cost-effective manner.

Delivery of Health Care↗

PubMed2000

Who needs a gatekeeper? Patients' views of the role of the primary care physician.

BACKGROUND: The primary care physician serving as a 'gatekeeper' can make judicious decisions about the appropriate use of medical services, and thereby contribute to containing costs while improving the quality of care. However, in Israel, sick funds competing for members have not adopted this model for fear of endangering their competitive stance. The purpose of this study was to examine, for the first time, the stated preferences and actual behaviour of a national sample of members of the four Israeli sick funds regarding self-referral to specialists, and to identify the characteristics of patients who prefer the gatekeeper model. METHODS: Data were derived from a national telephone survey carried out in 1997. A random representative sample of 1084 of all adult sick fund members were interviewed, with a response rate of 81%. Bivariate analysis was conducted using over all chi-square tests, and multivariate analysis was performed using logistic regression models. RESULTS: A third of all respondents prefer self-referral to a specialist, 40% prefer their family physician to act as gatekeeper and 19% prefer the physician to co-ordinate care but to refer themselves to a specialist. Independent variables predicting preference for the gatekeeper model are: living in the periphery, sick fund membership, low level of education, being male, fair or poor health status, having a permanent family physician and being satisfied with the professional level of the family physician. A significant correlation was found between practising self-referral and preference for self-referral. CONCLUSIONS.: The findings indicate the importance of surveying patients' attitudes as an input in policy formulation. The study identified specific population groups which prefer the gatekeeper model, and explored the advantages of a flexible model of gatekeeping.

Adult↗

PubMedDate not supplied

Diagnosis of inborn errors of metabolism.

Systematic detection of inborn errors of metabolism (IEM) has usually encountered difficulties in developing countries. We present our experience in a high-risk population in Mexico between 1973 and 1998 with particular reference to the last 10 years, during which time infrastructure and support were considerably improved. Only disorders of intermediary metabolism were sought. The total number of patients studied is not available, but in the last 10 years, patients numbered 5,186. Routine metabolic screening was performed on all patients, with additional tests according to the clinical picture and screening results. The referral criteria have increasingly diversified, one-third being neurological conditions. Of the referrals, 33.8% were from pediatricians (31.1% of whom were at critical medicine departments) and the remainder from specialists. The number of diagnosed patients has increased to 1 per 43.9 patients studied. Amino acid defects have been the most prevalent, the proportion of organic acid and carbohydrate disorders having increased in the last 10 years, associated with improved diagnostic facilities. The most frequently diagnosed diseases were PKU, type 1a glycogen storage, and maple syrup urine disease (MSUD), their frequency apparently varying among different regions of Mexico. Other results of our program include training of specialists and technicians, development of the Latin American Metabolic Information Network, a procedure to locally prepare a special food product low in phenylalanine for the treatment of PKU patients, and extension of approaches for these disorders to the investigation metabolic derangements of infant malnutrition. This work demonstrates that inherited metabolic diseases constitute a significant load in pediatric pathology and that their study can and should be pursued in developing nations.

Allied Health Personnel↗

PubMed2001

[The prevalence of undiagnosed type 2 diabetes mellitus in consulting rooms of general practitioners].

UNLABELLED: The aim of study was to estimate the prevalence of newly detected type 2 diabetic patients and compare it with prevalence of registered type 2 diabetic patients in the Slovak republic. The second aim was to improve the cooperation between general practitioners and diabetologists in the detection of unrecognized diabetes. PATIENTS AND METHODS: Seventy-six general practitioners were involved in Slovak Diabetologic Detection Program. Randomly taken capillary glucose (glucometer One-Touch, Lifescan) was measured in 18,942 probands over 40 years of age with one or more risk factors for type 2 diabetes in nine regions of Slovakia during a 6-month period. When capillary glucose was over 6 mmol/l the proband was referred to one of the nine diabetologic outpatient clinics for further evaluation. The history, physical examination and fasting capillary glucose or oGTT were performed in these patients. After exclusion of previously registered diabetic patients, noncompliant patients and insufficient examinations the data were evaluated in 15,387 probands. This data were compared with the Slovak National Registry, which is based on yearly collected and evaluated data from all diabetologic outpatient clinics. RESULTS: Newly detected (undiagnosed) type 2 diabetes was found in 444 (2.9%) and impaired fasting glucose and/or impaired glucose tolerance in 347 (2.3%) out of 15,387 probands. Data from Slovak National Registry show 9.5% type 2 diabetic patients over 40 years of age. In our detection program the number of undiagnosed type 2 diabetic patients over the age of 40 years was 2.9%. Therefore authors estimated the overall prevalence of type 2 diabetes in Slovakia over the age of 40 on 12.3% of general population in this age category (population ca 2.2 million people). When is compared prevalence of undiagnosed and registered type 2 diabetic patients it can be claimed that on three registered diabetic patients, there is one undiagnosed and one other with impaired fasting glucose and/or impaired glucose tolerance. The patients with undiagnosed diabetes and ones with impaired fasting glucose and/or impaired glucose tolerance had significantly higher body mass index and significantly higher occurrence of arterial hypertension and positive family history of diabetes compared to non-diabetic probands. Authors also achieved the second aim by establishing the collaboration between general practitioners and diabetologists in the selected nine regions of Slovakia. This relationship is essential for detection the undiagnosed diabetic patients by general practitioners and confirmation of diagnosis of diabetes as well as initiation of introductory education by diabetes specialists. Authors conclude that it is essential to actively screen for disturbances of glucose metabolism in population over 40 years old in general practice.

Adult↗

PubMed1994

Implications of generalists' slow adoption of zidovudine in clinical practice.

BACKGROUND: The lag time for adoption of new acquired immunodeficiency syndrome (AIDS) therapies into the clinical practices of different types of ambulatory care providers can be estimated from patient use of zidovudine therapy during the first few years after approval by the Food and Drug Administration. METHODS: We analyzed receipt of zidovudine therapy from April 1987 through March 1990 by 3643 patients with a diagnosis of AIDS. The study group was continuously enrolled in the New York State Medicaid program for at least 6 months after diagnosis. For each patient, the dominant providers of ambulatory care, receipt of zidovudine therapy, and consultation with a human immunodeficiency virus-AIDS specialist within 6 months after diagnosis were determined from Medicaid claims. AIDS specialists included physicians or clinics specializing in infectious disease or hematology/oncology or specific clinics within designated AIDS centers. RESULTS: In 1987, 55% of those who had an AIDS specialist as their dominant care provider received zidovudine therapy, compared with only 36% of patients with a primary care clinic as their dominant care provider. It was not until 1990, 3 years after approval by the Food and Drug Administration, that the percentage of patients receiving zidovudine therapy (77% to 78%) was comparable for patients of primary care clinics and AIDS specialists. In logistic regression analysis, zidovudine use did not differ between patients of AIDS specialists and patients with other types of dominant providers when the latter group had consulted with an AIDS specialist (adjusted odds ratio, 1.38; 95% confidence interval, 0.99 to 1.95). CONCLUSIONS: In our AIDS study population, there was at least a 3-year lag before patients of primary care clinics received zidovudine therapy at the same rate as patients of AIDS specialists. Conditions such as AIDS with rapid changes in treatment options may require a close relationship between generalists and specialists to increase access to new therapies.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Establishment of total and intraservice work by chiropractic physicians in providing spinal manipulative therapy and evaluation and management services.

OBJECTIVE: To develop and test a self-report survey instrument that measures the work performed by chiropractors in the delivery of evaluation and management (E/M) services and spinal manipulative therapy (SMT). Work is one leg of a triad used to develop Resource-Based Relative Values Scales (RBRVS) for physician reimbursement. DESIGN: Reliability study modeled after a tool designed and tested by economists at Harvard University School of Public Health in the development of relative values scales for physician reimbursement. The survey instrument uses magnitude estimation as a means of obtaining reliable and valid measures of the subjective assessments of the dimensions of a physicians work. SAMPLE: A random national sample was drawn from all members of the American Chiropractic Association. RESULTS: Estimates of the work performed by chiropractors in providing E/M and SMT services were established. The reliability of work ratings indicated that chiropractors agree closely on their ratings for work. The validity of the results indicated a high degree of consistency in rating work, which implies that the results are realistic. A review of demographics suggested that the survey population was representative of the general population of chiropractors. CONCLUSIONS: This study generated valid and reliable estimates of the work performed by chiropractors in providing E/M and SMT services. Work is one of three components used in the development of RBRVS, the method of physician reimbursement that is currently the industry standard. By quantifying the work required in providing services, chiropractors can now develop RBRVS. Additionally, the evidence-based data on work collected here can be used for a comparison with the work of similar services provided by other specialists. This can facilitate the use or modification of service description codes for use by chiropractic physicians.

Chiropractic↗

PubMed2001

[Screening for breast cancer on basis of individual risk assessment for women ineligible for the national population screening program].

For healthy women, without malignancies in their personal histories, a positive family history for breast cancer is the single indication for individual breast surveillance outside the population screening. Management of women is based on individual risk assessment. A cumulative risk of 20% and more, as a result of a positive family history, will in practice be an indication for breast surveillance. This threshold is not evidence-based yet, nor are data available on the benefits of this surveillance efficacy. When a personal cumulative risk of more than 30% exists to develop breast cancer, a consultation with a clinical geneticist involved in a family cancer clinic should be offered. Surveillance of women with a high-risk cumulative risk should preferably be included in a prospective study design. Only in this way will data about compliance and the estimates of different ways of surveillance become available. There is no convincing evidence that population screening for women aged 40-49 years does lead to important mortality reduction in combination with a good balance between pros and cons for the women involved. Women in the age category 50-75 years, with breast cancer in their personal histories, who are not followed anymore, should be informed by their specialist about participating (again) in the population breast screening. There is no evidence of mortality reduction as a result of breast self-examination nor of palpation performed by a physician. However, awareness of the own body can be useful for early recognition of breast abnormalities; it may reduce the delay between the first recognizable symptom and the subsequently initiated therapy.

Adult↗

PubMed2026

Digital and computational morphology in hematology: current platforms, clinical evidence, and future requirements.

INTRODUCTION: Morphologic examination of peripheral blood and bone marrow remains central to the diagnosis and classification of hematologic disorders. Conventional optical microscopy, however, is labor-intensive, dependent on operator expertise, and affected by interobserver variability. Digital morphology has developed from automated image acquisition and cell pre-classification into a broader field that includes whole-slide imaging, remote review, quantitative morphometry, and artificial intelligence-based analysis. CONTENT: This review examines current applications of digital morphology in peripheral blood, bone marrow aspirates, malaria detection, and body-fluid analysis. Commercial platforms are evaluated with particular attention to the distinction between raw automated pre-classification, expert digital post-classification, and comparison with independent optical microscopy. Digital systems generally perform well for common mature leukocyte populations but remain less reliable for rare or diagnostically critical cells, including blasts, abnormal lymphoid cells, plasma cells, and intermediate maturation stages. Research systems increasingly extend analysis from individual-cell classification to whole-slide, specimen-level, and patient-level assessment. SUMMARY: Digital morphology can improve standardization, image traceability, remote consultation, education, proficiency testing, quality assurance, and selected aspects of laboratory workflow. Its clinical value depends on appropriate validation, transparent reporting of reference methods, recognition of algorithm-specific failure modes, and clearly defined criteria for expert review and conventional microscopy. Human expertise remains essential not only for validating results but also for adapting cell taxonomies and interpretive rules to evolving classifications of hematologic diseases. OUTLOOK: Future progress will require representative multicenter datasets, harmonized morphologic terminology, external validation, interoperability with laboratory information systems, and continuous monitoring after software or hardware updates. Integration of morphology with quantitative hematology, flow cytometry, cytogenetics, genomics, and clinical data may support more comprehensive computational diagnosis. Digital platforms may also broaden access to specialist expertise, training, and quality programs in resource-limited institutions and regions, provided that infrastructure, governance, and professional competency are adequately supported.

artificial intelligence↗

PubMed2001

Effects of cost sharing on physician utilization under favourable conditions for supplier-induced demand.

The effects of cost sharing on the demand for ambulatory care in experimental circumstances are well understood since the Rand Health Insurance Experiment (HIE). However, in a non-experimental real-world context, supplier-induced demand of doctors might erode some of the significant negative out-of-pocket price elasticity identified in the HIE. Belgium is an interesting test case for this hypothesis because it has relatively high rates of patient cost sharing in its public health insurance system and a very high density of physicians, all remunerated fee-for-service. We have exploited the price variation generated by a substantial increase in patient co-payment rates in 1994 to estimate out-of-pocket price elasticities for three groups of users, and for three types of services using a fixed-effects model in levels and in differences. We obtain significant out-of-pocket price elasticities for the general population in the range from -0.39 to -0.28 for GP home visits, -0.16 to -0.12 for GP office visits and -0.10 for specialist visits. The estimates were generally lower and less significant for the groups of elderly and disabled. The differences we find in price responsiveness appear to be fairly robust and consistent with the HIE predictions. These results suggest that--at least in the short run--non-experimental utilization effects of cost sharing are very similar to the experimental evidence, even in a situation of favourable conditions for supplier-induced demand.

Ambulatory Care↗

PubMed2005

Multiple sclerosis management for low-income minorities.

Low-income minorities with complex chronic diseases and physical disabilities have difficulty accessing appropriate healthcare often resulting in suboptimal care. A survey was performed to determine the impact of cultural and socioeconomic factors on the quality of care for low-income minorities with multiple sclerosis (MS) enrolled in Independence Care System (ICS), a Medicaid long-term managed care plan. All 92 ICS members with a diagnosis of MS were surveyed on three aspects of their care: specialty contact, immunomodulating drug therapy and osteoporosis prevention. Of those surveyed, 32% were never seen by an MS specialist. One third were not taking immunomodulatory medications, primarily due to noncompliance caused by a lack of understanding about these drugs. The prevention of osteoporosis and potential fracture in this high-risk population was largely neglected by providers despite the fact that the majority of those surveyed also reported balance difficulties and a history of falling. The survey revealed several deficiencies in the care of low-income minorities with MS. A major issue was the lack of adequate education, particularly about the immunomodulating drugs. Education about the importance of osteoporosis prevention, falls mitigation programmes and rehabilitation evaluations are critical interventions to decrease the risk of fracture.

Adult↗

PubMed2006

Twelve-month prevalence, correlates, and treatment preference of adults with DSM-IV major depressive episode in Hong Kong.

BACKGROUND: The most recent large-scale community mental health survey of depression among adults in Hong Kong was conducted over two decades ago. The lifetime prevalence rates of DSM-III major depressive disorder (females 2.44% and males 1.29%) in that study do not tally with several indices of worsened social health and clinical prevalence studies of depression in contemporary Hong Kong. METHODS: Each of 5004 adults randomly drawn from the general population completed a telephone interview that generated the DSM-IV-based diagnosis of major depressive episode (MDE), sociodemography, help-seeking, and other epidemiological data. RESULTS: Twelve-month prevalence of MDE was 8.4%. The female-to-male ratio was low but typical of surveys in Chinese communities. Female sex and unemployment were associated with increased risk. 32.5% of respondents with MDE reported frequent thoughts of suicide. Recognition of the need for treatment of depression was high but actual treatment rate and preference for mental health specialists were low. LIMITATIONS: Response rate was low though cooperation rate was moderately high. Detailed demography, comorbidity, and clinical reappraisal interviews were not covered. CONCLUSIONS: Resolving issues of stigma and mode of symptom elicitation may lead to more valid prevalence estimates of depression among Chinese people. Although longitudinal studies are needed to confirm a genuine increase in prevalence, depression is likely to be more common in Hong Kong than previously suggested. High recognition of the need for treatment but low rate of actual treatment calls for policy and programs that improve access to treatment.

Adolescent↗

PubMed2003

Comparison of two, three and four 45 degrees image fields obtained with the Topcon CRW6 nonmydriatic camera for screening for diabetic retinopathy.

BACKGROUND: The use of the nonmydriatic camera is gaining increasing acceptance for the detection of diabetic retinopathy when integrated into a community-tailored program. We performed a study to evaluate the optimal number and positioning of photographic fields necessary to screen for diabetic retinopathy with the Topcon CRW6 nonmydriatic camera. METHODS: In this prospective masked cross-sectional comparative study, we compared the assessment of diabetic retinopathy using two, three or four 45 degrees fundus images (centred respectively on the disc and the macula; on the disc, on the macula and temporal to the macula; and on the disc, on the macula, temporal to the macula and superotemporal to the macula, including the superior temporal vein) acquired with the Topcon CRW6 nonmydriatic camera, with the grading of the seven standard stereoscopic 30 degrees field photographs (7SF). The study population consisted of 98 consecutive adult patients known to have type 1 or 2 diabetes mellitus who presented for the first time to the diabetic retinopathy clinic of a tertiary care centre in Montreal. All patients underwent four nonmydriatic fundus photography sessions of both eyes, 7SF photography with pupil dilation and a complete ophthalmologic examination with pupil dilation by a retina specialist. RESULTS: Compared to the 7SF, the sensitivity and specificity of screening for any retinopathy (Early Treatment Diabetic Retinopathy Study [ETDRS] grade greater than 10) using the two central fields were 95.7% and 78.1% respectively. The corresponding values with three image fields were 97.6% and 71.9%, and with four image fields, 97.6% and 65.6%. The sensitivity and specificity of screening for mild or worse disease (ETDRS grade 35 or greater) using the two central fields were 87.5% and 92.3%. The corresponding values with three image fields were 88.9% and 94.6%, and with four image fields, 88.9% and 91.9%. Poor image quality occurring with the addition of extra fields resulted in an increase of 6.2% in the rate of referral to an ophthalmologist. The use of two image fields missed no cases of retinopathy. INTERPRETATION: The use of image fields in addition to the two 45 degrees images centred on the disc and the macula on imaging with the Topcon CRW6 nonmydriatic camera did not significantly increase the sensitivity or specificity of screening for diabetic retinopathy. Contrary to the desired effect, the addition of fields resulted in diminished utility and cost-effectiveness of this screening approach.

Adult↗