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PubMed2004

[Knowledge of cardiovascular disease risk factors in open population of Tyumen and social gradient].

AIM: To study knowledge of cardiovascular disease (CVD) risk factors (RF) in open population of Tyumen with reference to social gradient. MATERIAL AND METHODS: Knowledge of CVD RF was studied in 2248 citizens of Tyumen (men and women, age 25-64 years) by means of mail questionnaire survey. The knowledge was assessed with consideration of education, occupation and marriage status. RESULTS: The examinees with primary education and manual labour workers were found to have little knowledge of the CVD RF while those with university education, engineers and specialists were well informed. Married population, widows and widowers knew about CVD RF more than divorced. CONCLUSION: The results of the study can serve a basis for a large-scale prophylactic program in open population of Tyumen.

Cardiovascular Diseases↗

PubMedDate not supplied

[From the ranch of the Tia Juana to Tijuana: a brief history of development and population on the northern border of Mexico].

"Tijuana has been the most extraordinary example of the modern demographic history of the [Mexican] northern border. This article is an essay on the economic, social, and demographic development of this important urban center during this century. Its purpose is two fold. On the one hand, to understand Tijuana's general population change in light of a unique socioeconomic development in the country, which has been characterized by a close dependence on the United States as well as by the creation of several federal programs aimed [at integrating] the natural economies. On the other hand, to introduce the discussion of the Mexico-United States border region to the non-specialist in this field." (SUMMARY IN ENG)

Americas↗

PubMed1993

The role of the psychosocial oncology CNS in a rural cancer outreach program.

The high cancer mortality rates in rural areas of Virginia are discussed, and cancer risk factors particular to the rural population are delineated. Rural health beliefs and their relationship to delay in seeking cancer care in rural areas are examined. A rural cancer outreach program and the role of the oncology clinical nurse specialist (CNS) in the program are described in terms of Psychosocial Oncology CNS subroles, i.e., clinician, consultant-liaison, networker/linker, coach, educator, change agent, researcher, and supervisor/supervisee. Effectiveness of the role in the program is analyzed. An innovative urban-rural nurse oncology program is delineated, and recommendations for research in rural nursing cancer care and actions for fostering CNS role development are suggested.

Attitude to Health↗

PubMed2004

Neonatal transitional care.

Challenging times lay ahead for very low birth weight (VLBW) infants and their families after hospital discharge. Ongoing medical concerns, respiratory complications, breastfeeding and feeding problems, inadequate growth and delayed development are frequently encountered by this vulnerable population. Families are burdened by the worry and work of caring for their VLBW infants at home. Specialized support in the community is needed to help in the transition of infants and families from hospital to home. The Neonatal Transitional Care Program (NTCP) commenced in 1997 to assist homeward bound VLBW infants and their families in the Calgary Health Region. The program team, consisting of clinical nurse specialists and a dietitian, provides in-home and telephone support for four months after infants are discharged. Extensive program evaluations reveal lengthened breast milk provision, decreased demand on healthcare resources (particularly emergency departments and pediatrician offices) and enhanced maternal confidence and satisfaction with community service. In this article, the development and evaluation of the NTCP are described. This innovative approach to caring for a vulnerable population of VLBW infants and their families is believed to be the first of its kind in North America. The NTCP models neonatal care that is seamless across the healthcare system and congruent with the needs of the infant and family.

Alberta↗

PubMed2005

HIV/AIDS and homelessness, Part 2: treatment issues.

Various factors interfere wtih proper access to and initiation of antiretroviral therapy in the HIV-infected homeless population, and it is important for health care providers to explore and address barriers to obtaining antiretroviral therapy and to foster a trusting relationship before offering therapy so that its success may be maximized. Patient education about the multifaceted aspects of antiretroviral therapy is a crucial component of care. Care providers should aggressively identify barriers to adherence and facilitate patient adherence by using multiple strategies, establishing solid lines of communication within the provider team, bringing program services to patients, and educating ancillary service providers about adherence. Comanagement of antiretroviral therapy requires an interdisciplinary approach that includes case managers, mental health and substance abuse counselors, shelter providers, medical specialists, and parole/probation officers. More research is needed to understand the complexities of HIV/AIDS within the homeless population and to develop treatment interventions.

Adolescent↗

PubMed2006

Challenges and opportunities of health care for the aging community in Lithuania.

The aim of this paper is to present the Lithuanian experience in creating a geriatric care system with the hope that it can be of some use to other countries undergoing similar transitions and changes. The Lithuanian population is old with 20% of the population being 60 years and older, and 15% being 65 years and older, with the trend toward a rapidly aging society. In 1990, Soviet rule in Lithuania ceased and the country regained its independence. With its recent acceptance into the European Union, the nation has set goals to meet the recommended requirements for the care of the elderly. The changes began with specialist training in gerontology and geriatrics, and were an essential first step to bridge the gap between the real and the future needs. Later, the Geriatric Care System Development Program was approved by the Ministry of Health. Despite its difficult past, Lithuania is confronting the challenges of health and social care of the aging population. It is embracing the opportunities to initiate policies and related measures to meet these challenges, and is potentially setting an example of good practice as a new European community.

Aged↗

PubMed2004

Cost analysis in telemedicine: empirical evidence from sites in Arizona.

CONTEXT: Support of telemedicine for largely rural and ethnically diverse populations is premised on expectations that it increases opportunities for appropriate and timely medical services, and that it improves cost-effective service delivery. PURPOSE: To understand the cost-effectiveness of telemedicine in 8 small and/or rural sites in Arizona. METHODS: A cost analysis framework was used to measure the efficacy of telemedicine in the selected sites from May 1, 2000, to April 30, 2001. FINDINGS: The costs for telemedicine services in half the study sites were more than the costs for conventional face-to-face diagnosis when the volume of telemedicine services used at a site was relatively low. This result persisted even when the opportunity cost for the patients in accessing more traditional types of care was included in the cost estimates. CONCLUSIONS: These preliminary findings suggest that telemedicine in some instances may not be cost-effective for providing medical specialists for underserved communities, particularly if these networks are underutilized by the patient population. Further analyses are needed to assess factors influencing utilization patterns of telemedicine services by underserved and ethnic communities before implementing these programs at clinical sites.

Arizona↗

PubMed1998

[Interaction of primary and specialized care and the patient in a program for early detection of cancer of the breast].

OBJECTIVE: To describe a method of carrying out an early detection programme (EDP) for breast cancer in a health area, as a coordinated activity between the primary care teams (PCTs) and specialist care. DESIGN: A descriptive, longitudinal study. SETTING: Area II of the Principality of Asturias. This is a predominantly rural and geographically very large area, although it has a high proportion of its population concentrated in several urban nuclei. PARTICIPANTS: The women between 50 and 65 registered as living in the area were chosen: a total of 3548. MEASUREMENTS: The participation, detection and biopsy rates, and the length of delays between different steps in the process were measured. These steps were: performing the mammography, further tests, receipt of the report, referral for treatment if appropriate. MAIN RESULTS: 2562 mammographies were carried out. There was 72.21% reply rate. 14 malign tumours were detected (detection rate 5.46 per 1000). The biopsy rate was 1.25%. The mean delay times were three days from the mammography to the primary care doctor's receiving the report; five days until the results were given to the patient; and 14 days before surgical treatment in case of breast cancer. CONCLUSIONS: The coordination between PCTs and specialist care considerably speeded up the development of the EDP for breast cancer in a large health area with a scattered population. Technically satisfactory results were achieved. The participation of the PC doctor enabled directed anamnesis and physical examination to be available and contributed to greater awareness among the target population.

Aged↗

PubMedDate not supplied

Performance of flexible sigmoidoscopy by a clinical nurse specialist.

According to the National Cancer Institute, 138,200 new cases and more than 55,000 deaths from colorectal cancer occurred in the U.S. in 1995. A high percentage of early cancers can be detected by screening asymptomatic persons older than age 50 with a digital rectal exam, fecal occult blood testing, and sigmoidoscopy. Evidence suggests that a decrease in mortality from colorectal cancer is associated with regular screening by sigmoidoscopy in an average risk population. As the population ages, more persons are eligible for colorectal cancer screening. Physician endoscopists are not available in all areas, and changes in reimbursement rates have caused some to discontinue this service. For these reasons, the Veterans Administration Medical Center in Buffalo, NY, developed a Colorectal Cancer Screening Program managed by a gastroenterology Clinical Nurse Specialist (CNS). Through study and supervision, the CNS has become proficient in the performance of 60-cm flexible sigmoidoscopic techniques and the diagnosis of multiple colon disorders, including sessile and pedunculated polyps, diverticulosis, tumors, hemorrhoids, and other conditions.

Colorectal Neoplasms↗

PubMedDate not supplied

Physician workforce reform in Lithuania: an inevitable transition.

The health system in Lithuania before independence was the same centralized system, the Semashko model that was prevalent throughout the former Soviet Union. The Soviet system focused more on quantity than quality, which resulted in a greater number of physicians per 100,000 than found in Western Europe. As in other Central and Eastern European countries, the health system in Lithuania has undergone substantial change since 1990. A major part of the reform of physician workforce in the former communist countries has been development of primary health care as a centerpiece of the health systems. This move in Lithuania has been hindered to some degree by the shortage of general or family practitioners. The focus on specialists in the old Soviet system led to a severe shortage of physicians in general practice. Only about 10% of physicians were general practitioners (GPs) in 1993 compared to a European Union average of 35%. That percentage had increased to 16% by 1998. Programs have been established to both train new GPs and to retrain specialists to become GPs, although a shortage of teachers and finances are problems facing these programs. Although the physician workforce in Lithuania has undergone substantial reform since 1990, real change has been slow. The physician to population ratio in Lithuania has failed to decline, moving from 387 per 100,000 population in 1991 to 398 in 1997, before dropping to 395 in 1998. The ratio remains substantially higher than current EU averages, reflecting a difficulty in reducing the number of physicians. Here we review what has happened to the physician workforce in Lithuania since independence and evaluate policies implemented. Efforts to reduce the number of physicians are also assessed. The results in Lithuania are compared to those in other CEE countries and to EU averages.

Adult↗

PubMedDate not supplied

Using an outside consultant for staff development.

In this article the author describes the use of a nurse educator/clinical nurse specialist as an outside consultant to provide a program to educate staff nurses about oncology patient care. The continuing education program included a didactic and clinical practicum. The program provided nurses with specialized knowledge about an expanding patient population, improved the level of oncology patient care, and increased the confidence of the physicians and community members in the level of oncology nursing care.

Clinical Competence↗

PubMed2005

Early effects of Asthma Prevention Program on asthma diagnosis and hospitalization in urban population of Poland.

BACKGROUND: Asthma is one of the commonest public health problems in Poland and the commonest chronic disorder in children. Lodz Regional Health Insurance Fund was a sponsor of the Prevention Asthma Program in 2000-03, directed at increasing early detection and providing optimal treatment of allergies by specialists in children. METHODS: All funds were divided between 127 primary and 12 specialized care centres participated in the programme. Primary care centre goals were: anamnestic information, mapping of allergy-causing factors, repeated auscultation of the lungs, bronchial dilation test, peak expiratory flow (PEF) measurement at the clinic and at home for 2 weeks. After preliminary diagnosis patients have been send to specialized centres. Specialized care centre goals were as follows: skin testing, spirometry, repeated bronchial dilation test, determination of eosinophilic white blood cells and eosinophil cationic protein (ECP) in blood. RESULTS: Increasing trend of new asthma diagnosis, expressed per 1000 inhabitants, was observed from 0.99 in 2000 to 2.19 in 2003. In the first year of Asthma Prevention Program, we observed more hospital episodes because of asthma exacerbation in comparison with year 1999 but from the second year of programme we showed systematically decreasing number of hospital episodes as a result of asthma exacerbation from 1.48 in 2000 to 0.84 in 2003. We found significantly decreasing trend in duration of hospitalization due to asthma exacerbation (P = 0.001). CONCLUSIONS: Effects of this programmes are: early identification of allergic diseases, mainly asthma, reduced number and shorter duration of hospitalization because of asthma exacerbation and establishing new Asthma Schools Education.

Asthma↗

PubMed2004

Advances in endovascular techniques to treat failing and failed hemodialysis access.

During the decade since JEVT was inaugurated, we have witnessed the growing application of endovascular techniques for arteriovenous (AV) access in parallel with the evolution of endovascular therapy for arterial pathology. To date, few if any technologies have compared with balloon angioplasty for treating venous anastomotic stenosis, the most common cause of access failure. Only one device, which incorporates the principles of access graft design and self-expanding stent technology, has been uniquely conceived for this pathology. The encapsulated polytetrafluoroethylene stent-graft has achieved reasonable preliminary results, but randomized data is forthcoming. Technology to clear the clot from a thrombosed graft continues to evolve, but will never be as cost-effective as simple balloon thrombectomy. However, the pressure placed on providers to perform all percutaneous interventions and move away from open techniques continues to fuel interest in this component of treatment. Finally, the pursuit of a completely percutaneous AV access continues. As with endovascular procedures in general, whether or not the procedure is cost-effective or time-consuming seems to take a back seat to the all-percutaneous approach that so many seem to converge upon. Moreover, as most autogenous fistulas and AV grafts can be created with minimal incisions under local anesthesia, the pursuit of a completely percutaneous access system seems more like an academic exercise than a practical application of technology. We must try and avoid the tendency to "minimize invasiveness" with technology that is maximally intensive (and expensive), such as limiting ourselves to only percutaneous methods. Given the increasing pressure to have an all autogenous access program, current techniques that apply well in prosthetic grafts will need to be modified to accommodate the different biology of a native fistula. Clearly, the enlarging end-stage renal disease population will continue to provide endovascular specialists with clinically challenging problems requiring new and revolutionary technology.

Angioplasty, Balloon↗

PubMed2006

A population-based follow-up study on gallstone disease among type 2 diabetics in Kinmen, Taiwan.

AIM: To assess the incidence of and risk factors for gallstone disease (GSD) among type 2 diabetics in Kinmen, Taiwan. METHODS: A screening program for GSD was performed by two specialists who employed real-time abdominal ultrasound to examine the abdominal region after patients had fasted for at least eight hours. Screening, which was conducted in 2001, involved 848 patients diagnosed with type 2 diabetes. After exclusion of 63 subjects with prevalent GSD, 377 participants without GSD were invited in 2002 for a second round of screening. A total of 281 (74.5%) subjects were re-examined. RESULTS: Among the 281 type 2 diabetics who had no GSD at the first screening, 10 had developed GSD by 2002. The incidence was 3.56% per year (95% CI: 1.78% per year-6.24% per year). Using a Cox regression model, age (RR = 1.07, 95% CI: 1.00-1.14), waist circumference (RR = 1.12, 95% CI: 1.01-1.29), and ALT (RR = 1.13, 95%CI: 1.01-1.26) appeared to be significantly correlated with development of GSD. CONCLUSION: Older age is a known risk factor for the development of GSD. Our study shows that greater waist circumference and elevated ALT levels are also associated with the development of GSD among type 2 diabetics in Kinmen.

Adult↗

PubMedDate not supplied

Practice patterns of respirologists in Canada.

The demographics and practice patterns of respirologists in Canada have not been studied. To evaluate the demographic characteristics of respirologists in practice, appraise current respirology manpower and ascertain the utilization of invasive diagnostic and therapeutic procedures (interventional pulmonology), a mail survey of all Canadian respirologists was conducted. The questionnaires were completed by 62% (n=355) of 573 possible participants. Of the respirologists who responded, 69.2% were younger than 50 years of age, 70.3% had been in practice for fewer than 20 years, 64.4% were in full- or part-time academic practice, and 72.9% were based in urban centres with a catchment population of more than 250,000. The current ratio of respirologists to population in Canada, assuming a total population of 31,000,000, is 1:54,101. In the present survey, only 68.3% respirologists practised clinical respirology for 50% or more of their time, and half (49.5%) of respirologists devoted more than 50% of their time on nonrespirology or nonclinical activities. Thus, the more precise respirologist to population ratio appears to be 1:81,000. The current ratio meets the Royal College of Physicians and Surgeons of Canada recommendations, and the current training programs meet present manpower requirements. With respect to the procedures performed, most specialists carried out bedside procedures and flexible bronchoscopy; a much smaller number did invasive procedures such as rigid bronchoscopy (20.8%), transbronchial needle biopsy of lung (43%), transbronchial biopsy of mediastinal lymph nodes (38%), therapeutic bronchoscopy using laser, cryotherapy and stents (8.7%), transthoracic needle biopsy (22.2%) and thoracoscopy (11.3%). Because 97% of pulmonary specialists would like to perform invasive procedures, fellowship programs, mini-residencies and practical courses should provide the necessary training.

Adult↗

PubMed1999

Software for population pharmacokinetics and pharmacodynamics.

Pharmacokinetic-pharmacodynamic modelling is being used increasingly as a tool in drug development because often in phase III clinical trials only sparse data are available for analysis and so a nonlinear mixed effects modelling approach has to be adopted. Specialist data analytical techniques and software are required to analyse such data. This article reviews some of the software currently available for performing nonlinear mixed effects modelling. A questionnaire was devised and sent to a number of software producers and the findings are presented and discussed in this paper. The programs could be grouped into 3 main categories: parametric and nonparametric maximum likelihood and Bayesian. It was apparent from the questionnaire that software development for population data analysis is a very active area of investigation. The implementation of methodologies varied widely between the packages: some were self-contained programs, whereas others were written within another application, usually a statistical package. They also varied with respect to their ease of use and level of support offered by the software producers. Although robustness and reliability are important concerns, they were not addressed in the present review. Most of the programs surveyed are in continual development.

Animals↗

PubMedDate not supplied

Future prospects of population-based mammographic screening.

Mammographic screening is one worthwhile way of reducing deaths from breast cancer among women diagnosed in ages 50-69. Our knowledge is less clear for women below 50 and above 70. Major research issues include whether by new approaches we can achieve a definitive mortality reduction in women under 50 and investigations of the efficacy of screening in the elderly. The optimal interval time has yet to be decided. When screening is taken to previously unscreened populations, effects on many parameters have to be followed, e.g., sensitivity, specificity, positive predictive value, gains, and costs. We do not as yet know what the implications of finding large numbers of women with in situ cancer are. Keeping high standards in population-based programs also means fighting potential drawbacks: minimizing the proportion of "unnecessary" biopsies and anxiety, avoiding over-treatment of cancers with excellent prognosis, preventing false reassurance or that women with suspicious findings are left without advice. Potential drawbacks of screening are best dealt with within a team of specialists on breast cancer diagnosis and treatment. Mammographic screening has become widely accepted as one important way of reducing breast cancer deaths, and this success has been dependent on the fact that its development has been science driven. To continue to develop, the tradition of critical evaluation and unsentimental bold testing of new ideas has to be carried on.

Adult↗

PubMed2000

Tuberculosis in Russia.

Various aspects of tuberculosis in Russia, including epidemiology, means of prevention, diagnosis and treatment, have been widely discussed in the last few years in the medical literature and by the general media. A certain amount of controversy has been generated on some of these subjects. This review is an attempt to objectively analyze the true situation of tuberculosis in Russia, including the issues of control measures, as viewed by the public health authorities and by the majority of Russian tuberculosis specialists. The data presented and their analysis reflect the official position of the Russian Federation Ministry of Health. These views became a basis for the concept of the national anti-tuberculosis program to serve the needs of the population, which was approved by the Scientific Council of the Ministry of Health of Russia in February 2000.

Communicable Disease Control↗