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PubMed2002

Current colorectal cancer screening strategies: overview and obstacles to implementation.

Colorectal cancer is the second leading cause of cancer death but is largely preventable. Current strategies to prevent colorectal cancer vary considerably with regard to effectiveness, up-front costs, risks, and invasiveness. Current levels of participation in colorectal cancer screening in the U.S. population are low. Both physician and patient attitudes contribute to low levels of screening uptake. New colorectal cancer tests are one mechanism to improve adherence. Virtual colonoscopy may have an important impact if techniques to perform it without bowel preparation can be developed. Stool-based DNA testing is likely to be the most effective entirely noninvasive strategy and will be easier for patients to perform than fecal occult blood testing. The potential for improvements in the technology are substantial, and data from second-generation assays have already been reported. The cost-effectiveness of new strategies needs further evaluation.

Barium Sulfate↗
PubMedDate not supplied

Is homelessness hazardous to your health? Obstacles to the demonstration of a causal relationship.

BACKGROUND: Homeless people suffer from high levels of morbidity and mortality, but there is surprisingly little empiric evidence that homelessness has a direct adverse effect on health. METHODS: This study examined the relationship between shelter use and risk of death using longitudinal data in a cohort of 8,769 homeless men in Toronto, Ontario. Shelter use was modelled as a time-dependent covariate in a Cox regression analysis. RESULTS: In a model adjusted for age and previous pattern of homelessness, the risk of death during months in which homeless shelters were used was significantly increased (hazard ratio, 1.84; 95% confidence interval, 1.27-2.67). CONCLUSIONS: Among men, periods of homeless shelter use are associated with higher mortality. There are three reasons why this finding does not necessarily mean that homelessness itself increases the risk of death. First, the hazard of death associated with shelter use compared to non-shelter use may be significantly different from that associated with homelessness compared to non-homelessness. Second, the association between shelter use and risk of death may be confounded by other variables such as alcohol and drug use. Finally, because the mechanism and time-course of the putative effect of homelessness on health is uncertain, appropriate modelling of the time-dependent covariate is difficult to ensure. Further research into the possible adverse effects of homelessness on health is needed and would have important implications for public policy.

Adolescent↗
PubMed2002

[Obstacles to the routine discussion with hospital patients of possible cardiopulmonary resuscitation].

Nowadays, cardiopulmonary resuscitation is not routinely discussed with all hospital patients, even though it should be for a number of reasons. First of all, every patient may suffer cardiac arrest, and the overall outcome of a subsequent attempt at resuscitation is difficult to predict. Besides, patients who do not wish to be resuscitated often do not tell that to the physician of their own accord. Patients should therefore be more actively informed and encouraged to express their own preferences. The routine discussion of possible resuscitation gives physicians the opportunity to discuss, determine and delimit the extent of the intended medical procedure. In the literature, communication problems in three different areas can be identified as a cause of the present situation. These are--for both physician and patient--inability, lack of insight and unwillingness to discuss resuscitation. Physicians should be aware of the identified communication problems and deal with them in a professional manner. An understanding of these problems forms the basis for a broader implementation of resuscitation discussions in hospitals.

Advance Care Planning↗
PubMed2002

[Obstacles of soybean continuous cropping, III. Mechanism of soybean yield increment by marine actinomyces MB-97].

An isolate of marine actinomyces MB-97 identified as Streptomyces microflavus could successfully colonize in the rhizoshpere of soybean, and inhibit Penicillium purpurogenum, a soybean deleterious rhizospheric microorganisms. After applied MB-97, the ratio of bacteria/fungi in the rhizosphere of soybean was increased, and the soil became to be "Bacterial type" from "Fungal type". The populations of P. purpurogenum were apparently suppressed about 80%, and the harm of toxins in soil was weak. The soybean root rot caused by soilborne fungi such as Fusarium was decreased 50%, and MB-97 could stimulate the growth of soybean seedlings. In field study, the mean yield of soybean raised by 15.2%, implying that Streptomyces microflavus was an effective plant growth-promoting rhizobacteria on soybean.

Actinomyces↗
PubMed2002

Implementation of three Rs alternatives in regulatory testing: possibilities and obstacles--the view of the validator.

After the establishment of the European Centre for the Validation of Alternative Methods (ECVAM) in 1993, the Scientific Advisory Committee (ESAC) decided at its first meeting that the implementation of the Three Rs in the production and quality control of biologicals should be one of ECVAMs priorities. In collaboration with experts, ECVAM has established guidelines on the pre-validation and validation of alternative toxicological methods, which are as applicable to alternative methods in the quality control of biologicals as they are to the testing of industrial chemicals. This paper explains the technical information which should be submitted to ECVAM to assess the readiness of a method for pre-validation, which is defined as a small-scale interlaboratory study to confirm that an optimised and transferable protocol is available. Where appropriate, a formal validation study is then conducted, to evaluate the scientific relevance and reliability of the test method.

Animal Testing Alternatives↗
PubMed2003

Private health care sector investment in Brazil: opportunities and obstacles.

The Brazilian health system is based upon the constitutional right formulated in 1988, according to which health is the peoples' right and duty of the State. So being, it is essentially the government's responsibility, expressed in the so-called Sistema Unico de Saúde--SUS (single health system) Since its creation, however, it admits the existence of a supplementary health system, left to the private sector. In general terms, the public system is considered unsatisfactory in the services it renders. Its resources are distributed heterogeneously, favoring centers of advanced medical practice, to the detriment of basic health care. The supplementary system is considered of better quality, however with great variations and frequent accusations of being essentially profit driven, instead of being driven to the needs of the assisted population. The growing search for health plans is a direct consequence of the image perceived by the population regarding the quality and accessibility of the public services, as well as of the peoples' growing consciousness of their needs, rights and duties as citizens. The need for continuous quality improvement and cost reduction offers numberless opportunities for actions and investments. Initiatives to identify and implement the best medical practices, medical guidelines and actions are essential regarding those illnesses which are most frequent, of higher cost and of greater risk. Health plans and healthcare providers will necessarily have to focus on their common client. Therefore, organizations must be created in order to develop initiatives aimed to the quality of patient care, as well as to the collection and dissemination of data regarding the production and results of the main service providers. Consequently, immense opportunities are being opened for investments in the area of Information Technology, collection, analysis, and data dissemination. This paper analyses the main trends in the Brazilian health sector and from the data and tendencies, draws various conclusions on the opportunities and barriers for private investment.

Brazil↗