Family planning program sustainability: threat or opportunity?
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Family Planning Services↗
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General theory of paradigms in health.
In Costa Rica, three sequential health paradigms have been identified over the last 50 years. The first began to develop during the 40's and has been called that of the deficiency diseases, since with a diachronic approach it placed excessive emphasis on malnutrition. The second began in 1970 and it is known as that of the infectious diseases, since through a holistic or synchronic approach, it underlined the importance of infections in high rates of morbidity and mortality. The third and last is the paradigm of the chronic diseases, it appeared in the 80's and is presently in process, doing battle with the chronic ailments, life styles, and environment, and it also utilizes a holistic approach. The recognition of these three paradigms has permitted Costa Rica a rapid advance in improving the health of its population, to the point that with a per capita outlay of $130 (US dollars), it has indices similar to those of the industrialized nations. This particular experience could be useful for other less-developed countries that are still applying the paradigm of the deficiency diseases.
Adult↗
Current principles of rehabilitation for patients with rheumatoid arthritis.
Rehabilitation is rooted in the comfort and palliation that sufferers of rheumatic symptoms have sought from physical modalities throughout history. In recent decades, several of these empiricisms have been tested scientifically. Furthermore, function has joined comfort as a desirable and measurable outcome. This article highlights some of the more substantive information as it relates to rheumatoid arthritis. It is clear that such information facilitates more effective and efficient programs of intervention. It is equally clear that the therapeutic perspective of rehabilitation for rheumatoid arthritis is more appropriately applied throughout the course of the disease in an ongoing program of habilitation than held in reserve as a form of salvage.
Arthritis, Rheumatoid↗
[Economic impact of nosocomial infections on the Metropolitan Hospital Complex of the Social Security Fund (from January through December, 1987)].
Nosocomial infections increase the morbidity, mortality and cost of hospitalization. The Hospital Infection Committee of the Metropolitan Hospital Complex of the Caja de Seguro Social de Panama studied the problem of nosocomial infections in 1987 and showed that of 29,576 admissions, 820 patients developed 994 nosocomial infections (an annual incidence of 3.69%). This resulted in 5191 additional days of hospitalization, at a conservatively estimated cost of B/ 840,153, and was responsible for 24 deaths. An adequate and efficient program of control of nosocomial infections in recommended.
Cross Infection↗
[Medical indications for abortions induced in the 2d trimester of prenatal life. Epidemiological considerations and prospects of prevention].
A review of more then 20,000 induced abortions led to recognize a series of about 1,500 late abortions induced upon medical indication during the second trimester of pregnancy, in accordance with the 1978 italian Law. About 20% of these abortions were performed in teen-agers. Only 3.5% of these 1.500 abortions corresponded to the classic "therapeutical" motivation due to danger to the physical health of the mother. Eugenic abortions induced by ascertained fetal malformation, chromosomal abnormality or other suspected prenatal pathology, could be identified in 36.9% of cases, even if legal motivation went correlated to the mental health of the mother. In 59.6% of cases motivation was a peculiar psycho-emotional condition of mother suffering, inducing fear for her mental health. Data were analysed and correlated to a series of relevant variables. Considerations of general value regarding the prevalence of the phenomenon of rejected pregnancies, the rate of spontaneous abortions, and the lack of birth control, are based on the comparison of the results with those of the first trimester induced abortions, spontaneous abortions and natality rate recorded in the same Hospital, in the population of Milan and in the italian largest region, Lombardy. Consistently with the recognition, based on biological, medical and ethical ground, of the presence of a new human life during pregnancy, the Author stresses the need for a realistic approach to the problem also from the legal and medical point of view. In particular, the urgent need for comprehensive and efficient programs of prevention of abortion, which still remains all over the world a major challenge for society, human dignity and modern gynaecological science is emphasized.
Abortion, Induced↗
Costs of treating diarrhoea in a children's hospital in Mexico City.
The treatment received by children aged under 5 years with diarrhoea was studied in the Hospital Infantil de México (Federico Goméz), Mexico City. The costs of treatment were calculated and estimates were made of how these had changed since the establishment of an oral rehydration unit in the hospital in 1985. The results indicate that drug treatment of outpatients was generally appropriate and inexpensive. In contrast, the cost of drugs for inpatients was considerably higher. The seriousness of the cases justified much of this additional expense for inpatients, but there is evidence that the costs could be reduced further without jeopardizing the quality of the care. Diagnostic tests were relatively expensive, frequently failed to identify diarrhoeal etiology, and their results correlated poorly with the treatment prescribed. The oral rehydration unit resulted in significant savings by causing a 25% fall in the number of inpatients with diarrhoea.
Antidiarrheals↗
Selective screening for abdominal aortic aneurysms with physical examination and ultrasound.
Abdominal aortic aneurysm (AAA) is an important cause of preventable death in older persons. Persistently high rupture mortality rates indicate that these deaths can be prevented only by early detection and treatment of AAA. In an effort to develop an effective and efficient program of AAA detection, we selectively screened a high-risk population. Men aged 60 to 75 years with hypertension and/or coronary artery disease were randomly selected from a general medicine clinic and screened with physical examination and ultrasound. Eighteen previously unsuspected aneurysms, 3.6 to 5.9 cm in size (mean, 4.4 cm), were detected in 201 patients, for a prevalence of 9% (95% confidence interval: 4.7% to 13.3%). The specificity and positive predictive value of ultrasound were each 100%. Abdominal palpation detected only half of these aneurysms, but missed none in patients with an abdominal girth less than 100 cm (n = 6). This degree of sensitivity did not occur with "routine" examinations and requires that the examination be directed specifically toward AAA detection. We conclude that undiagnosed AAAs are common in this large subgroup of the clinic population, that ultrasound is an excellent screening test for AAAs, and that physical examination may be adequate for screening thin patients. We recommend that every two or three years persons over the age of 50 years undergo careful abdominal palpation aimed at detecting AAAs, as part of the periodic health examination. We further recommend that obese older men at high risk for AAA have at least one-time screening with abdominal ultrasound, regardless of findings on physical examination.
Abdomen↗
The high costs of health care in Brazil.
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Brazil↗
Higher density of mental capacities in the left cerebral hemisphere of man: a quantitative investigation in children with localized cerebral lesions.
51 children with localized cerebral lesions were investigated with the British Ability Scales, Wechsler test, Porteus Mazes, Conners Teacher Rating Scale, and computerized tomography. The extent of the lesions was quantitatively determined. The IQ was 10 points lower in the left hemispheric lesions, although the right hemispheric lesions were larger. When corrected for size of lesions, the IQ is 17 points higher (p less than 0.05) in children with right than with left hemispheric early lesions. The children with left hemispheric lesions had also significantly more behavioural problems (Conners Scale). Children with bilateral lesions had 15 points lower IQ than those with unilateral lesions, although from the slightly larger extent one could expect only 3 points difference. There was no influence of hemiparesis or of epilepsy of the IQ independent of the extent of lesion. There was more plasticity of the hemisphere than of the lobes as shown by Wisconsin Card Sorting data. The higher density of mental capacities in the left cerebral hemisphere of man is explained by more efficient programs, and more dense packing of functions due to more training of the left cerebral hemisphere.
Adolescent↗
[Mathematical modelling of glycolysis and adenine nucleotide metabolism of human erythrocytes. I. Reaction-kinetic statements, analysis of in vivo state and determination of starting conditions for in vitro experiments].
A mathematical model of energy metabolism of human red cells is presented, which includes besides the glycolytic reactions the adenine nucleotide metabolism. The model is based on the network of chemical reactions, the thermodynamic equilibrium constants of fast reversible reactions and on the kinetic equations for irreversible enzyme reactions. The model consists of a system of 16 differential equations and allows the mathematical evaluation of metabolic levels in the steady state of energy metabolism corresponding to the in vivo state erythrocytes with the kinetic data for the enzymes derived from in vitro experiments. The dependence of the levels of metabolites in the steady state on the activity of some enzymes is analysed to characterize the regulatory properties of the system. The comparison of the steady state levels of the model with experimental data makes it possible to estimate values of some controversial enzyme parameters. Estimates of the kinetic parameters of the following intracellular processes are presented: 1) rate constant of AMP-phosphatase, 2) maximum rate of adenylate deaminase, 3) activity of adenine phosphoribosylpyrophosphate transferase and 4) adenosine transport through the cell membrane. The simulation of the preparatory phase before incubation of erythrocytes indicates, that the model also permits to compute the time course of changes of levels of metabolites. To solve the initial problem the stiff differential equation system is integrated numerically by an efficient program without the application of the quasi-steady-state approximation.
Adenine Nucleotides↗
Modifications for the Starkey Hearing Science Laboratory.
Directions were given to modify the Starkey HSL for more efficient programming capabilities (Memory Address Modifier), subject response (Response Box), and feedback (Logic Control) functions. These modifications improved classroom demonstrations in that subject response, as in actual experiments, may be demonstrated, and more than one experiment can be programmed prior to class. These changes also improved the HSL potential for clinical and research applications.
Audiology↗
Decentralization/regionalization in health care: the Quebec experience.
The decentralization policy in Canada was initially aimed at decentralizing the management of services by creating regional bodies within which interested parties would participate in establishing priorities, elaborating programs, allocating resources and assessing program efficiency and effectiveness. A look at the Quebec experience provides insight into the difficulties and implications of decentralization.
Catchment Area, Health↗
Medicaid reform: an opportunity for the osteopathic medical profession.
Established in 1965 to provide medical care for the impoverished, the Medicaid program has pitted state governments against the federal government, and made adversaries of the providers. The authors examine the legislative history of the program and the rapid growth of expenditures that have led states to cut benefits, tighten eligibility requirements, and slash payments to providers. The call for comprehensive healthcare reform and universal access put Medicaid at the forefront of proposed changes. The osteopathic medical profession, which already provides a quarter of the care in the program, has an opportunity to lead in innovation to promote program efficiencies, and to affirm the profession's commitment to serve vulnerable populations.
Forecasting↗
Identifying profoundly mentally retarded subtypes as a means of institutional grouping.
While the profoundly mentally retarded social group is behaviorally heterogeneous, this knowledge appears to be of more theoretical than practical interest. The behavioral identification of functional profoundly retarded subtypes derived from ethological analysis may supply the structure necessary to utilize this behavioral variability. Institutional groupings based on dominant and subordinate subtypes may prove to be efficacious in increasing programming efficiency. A study of profoundly retarded persons' territoriality was discussed as it relates to new grouping procedures based on behaviorally identified subtypes. Implications with respect to the control of aggression, stereotypic activity, and behavior modification for functional subtypes were discussed.
Adult↗
An overview of the effectiveness and efficiency of HIV prevention programs.
Because of the enormity of the HIV-AIDS epidemic and the urgency for preventing transmission, HIV prevention programs are a high priority for careful and timely evaluations. Information on program effectiveness and efficiency is needed for decision-making about future HIV prevention priorities. General characteristics of successful HIV prevention programs, programs empirically evaluated and found to change (or not change) high-risk behaviors or in need of further empirical study, and economic evaluations of certain programs are described and summarized with attention limited to programs that have a behavioral basis. HIV prevention programs have an impact on averting or reducing risk behaviors, particularly when they are delivered with sufficient resources, intensity, and cultural competency and are based on a firm foundation of behavioral and social science theory and past research. Economic evaluations have found that some of these behaviorally based programs yield net economic benefits to society, and others are likely cost-effective (even if not cost-saving) relative to other health programs. Still, specific improvements should be made in certain HIV prevention programs.
Adolescent↗
Increasing practice efficiency by linear programming.
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Dental Assistants↗
Marker-assisted introgression in backcross breeding programs.
The efficiency of marker-assisted introgression in backcross populations derived from inbred lines was investigated by simulation. Background genotypes were simulated assuming that a genetic model of many genes of small effects in coupling phase explains the observed breed difference and variance in backcross populations. Markers were efficient in introgression backcross programs for simultaneously introgressing an allele and selecting for the desired genomic background. Using a marker spacing of 10-20 cM gave an advantage of one to two backcross generations selection relative to random or phenotypic selection. When the position of the gene to be introgressed is uncertain, for example because its position was estimated from a trait gene mapping experiment, a chromosome segment should be introgressed that is likely to include the allele of interest. Even for relatively precisely mapped quantitative trait loci, flanking markers or marker haplotypes should cover approximately 10-20 cM around the estimated position of the gene, to ensure that the allele frequency does not decline in later backcross generations.
Alleles↗
[Program for the detection and control of arterial hypertension in the work environment (III). Data relating to the control and efficiency of the program].
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Adult↗