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PubMed1999

Health, environment and sustainable development: identifying links and indicators to promote action.

This paper discusses the links among health, environment, and sustainable development and presents a framework that extends from the epidemiological domain to the policy domain and includes the driving forces that generate environmental pressures, creating changes in the state of the environment and eventually contributing to human exposures. Health effects are the end result of this complex net of events. Environmental health interventions should not be limited to treatment of cases and directly reducing human exposures. The paper discusses the need for integrated action at all levels and, in particular, on the need to focus on long-term action directed at reducing the driving forces that generate the environmental health threats. Only this approach can achieve sustained health benefits and environmental protection in accord with the principles of sustainable development.

Decision Support Techniques↗
PubMed1999

Brain inflammation in Alzheimer disease and the therapeutic implications.

Immunohistochemical studies suggested the existence of a chronic inflammatory condition in affected regions of the brain in Alzheimer disease (AD). Since inflammation can be damaging to host tissue, it was hypothesized that antiinflammatory drugs might inhibit both the onset and the progression of AD. This hypothesis is supported by a number of epidemiological studies suggesting that the prevalence of AD in persons is reduced by 40 - 50% in persons using antiinflammatory drugs. In one small pilot trial in early AD, the nonsteroidal antiinflammatory drug indomethacin appeared to halt the progressive memory loss. Immunohistochemical and molecular biological studies on immune system components in AD brain are revealing the complexities of the innate immune reaction. This very complexity may offer points of therapeutic intervention for new types of antiinflammatory agents. The complement system, microglia and cytokines are key components. This review summarizes the present state of knowledge on the immune system elements found in AD brain.

Alzheimer Disease↗
PubMed1999

[Crohn's disease from the viewpoint of psychosomatic and behavioral medicine].

In a group of patients suffering from Crohn's disease increased incidence of affective symptoms, mainly high degree of neurosis and depressions, was detected with the use of psychological methods. Social relations and status may influence the course of the disease. Social support, information on the disease and patients higher educational degree have positive effects on the acceptation and compliance of the disease. Surprisingly negatively is the disease influenced by stable partnership and parenthood. Affective symptoms can be managed with the use of psychological methods. We proved it on reconditioning stays with structured programme. Their application led to reduction of neurotic and depressive symptoms, improvement of physical condition, better ability to relax physically and emotionally, the ability to harmonize psychical and physical functions, to cope with stress and the patients have established social contacts with other persons suffering from the same disease with the aim to promote conscious care of one's own health condition. Psycho-educational programme is extraordinary important in new diagnosed patients, for their ability to cope with the disease, and as a help for their future life arrangement. The techniques used to deal with stress can be helpful for prolonging the remission period. It was confirmed that psychological methods may contribute to life quality improvement in Crohn's disease patients. Self-help activities in the form of clubs and reconditioning stays reveal as very useful. Psycho-social intervention should become a part of complex care of patients with Crohn's disease. (Tab. 1, Fig. 1, Ref. 22.)

Adult↗
PubMed2001

Transcatheter Closure of Patent Ductus Arteriosus Using the Amplatzer Duct Occluder.

The Amplatzer duct occluder (ADO) (AGA Medical Corp., Golden Valley, MN) is designed to meet criteria for an optimal transcatheter technique for closure of a patent ductus arteriosus. It was developed as an alternative to surgical closure and other interventional techniques. It is not technically complex, allows controlled deployment, is retrievable and repositionable, and has a low risk of embolization. The ADO also has very high complete closure rate at 1-month follow-up comparable to surgical ligation and division.

Journal Article↗
PubMed2002

Temporary vena cava filter placement for pulmonary embolism.

Current clinical trials are under way to determine the safety and efficacy of temporary inferior vena cava filters for use in patients who need but have contraindications to anticoagulation medications for a short time (<10 days). To date, no data on these types of filters have been published. The authors describe a 20-year-old male trauma patient in whom a pulmonary embolism developed early in his hospital course and who was appropriately placed on anticoagulation therapy. Surgical intervention, however, was necessary to repair complex facial fractures sustained in a motorcycle collision. A filtering infusion catheter was placed until anticoagulation therapy could be resumed. The patient tolerated the surgery without further embolism and has recovered without difficulty.

Accidents, Traffic↗
PubMedDate not supplied

[Surgical treatment of cysts and cyst-like formations of pancreas].

Results of treatment of 87 patients with cystic pancreatic formation were analyzed. In 38 patients pancreatic cyst had formatted after destructive pancreatitis, in 28--after pancreatic trauma, in 6--due to virsungolithiasis, in 9--cystadenoma was revealed, in 6--cystadenocarcinoma. In 29 patients operation of internal drainage of cyst was performed. Basing on accumulated experience the authors recommend to perform puncture-cathetherizational intervention under ultrasonic investigation and computeric tomography control, when nonformated or complicated pancreatic cyst is present; in the treatment of uncomplicated nonformated pancreatic cyst the operation of internal drainage, using different organs, stomach, duodenum, small intestine, constitutes the method of choice. When it is impossible to perform puncture-cathetherizational intervention, external drainage of cyst and complex conservative therapy may become the method of choice for the treatment of complicated pancreatic cyst. In the presence of benign cystose tumor it is necessary widely apply radical operation--pancreatic resection. The largest frequency of complications occurrence have been noted after external drainage of cyst, performance of cystogastrostomy, pancreatic resection for cystadenoma and cystadenocarcinoma. The principal of them are: the external pancreatic fistula occurrence (in 9.1% of observations), the cyst recurrency (in 5.7%), erosive hemorrhage (in 4.6%), pancreatitis (in 5.4%), suppuration of postoperative wound (in 8%), stenosis of cystodigestive anastomosis (in 2.3%). Postoperative mortality was 6.8%.

Adolescent↗
PubMed2004

[The cause of re-stenosis in the stent].

One of the probable causes of restenosis occurrence in the stent was analyzed. Experience of surgical treatment of 59 patients with an acute vascular trauma, of the complex cutaneous flaps transplantation and of interventions on lymphovenous system was summarized. There were also conducted experimental investigations in 64 rats and in 54 rabbits, histological preparations of the vessels wall were studied. There was proved that restenosis in the stent may occur due to atrophy of muscular layer of artery, migration and subsequent proliferation of the smooth muscle cells in neointyma after sclerosis of adventitia. It is necessary to use for the stents manufacturing an expansible-dynamical constructions, which promote an active functioning of muscular layer of arterial wall without causing its atrophy.

Adolescent↗
PubMed2003

Tracking alcohol consumption over time.

Researchers are tracking long-term changes in alcohol consumption and related behaviors or outcomes in order to detect trends in the entire population or certain subgroups, test models of alcohol-related outcomes, and understand the consequences of interventions. Such analyses must consider the complexity of typical lifetime consumption patterns. Major approaches to measuring alcohol consumption over time include aggregate measures of consumption (e.g., sales data), cross-sectional surveys, and longitudinal or panel surveys. When analyzing the data, researchers must try to ensure the comparability of measurements over time. The stability of various measures and the potential for combining different types of data are also important considerations when tracking alcohol consumption over time. If these requirements are met, the regular collection of data on aspects of alcohol consumption will greatly increase researchers' understanding of the forces influencing a population's alcohol consumption and its consequences.

Alcohol Drinking↗
PubMed2004

Memory: Pandora's hippocampus?

Greater knowledge of the human brain has enabled us to begin devising therapies to rescue or modify memory for the afflicted, such as Alzheimer's patients or post-traumatic stress disorder victims. This same knowledge could also allow us to alter how normal, healthy memory operates; we may become able to enhance memory and learning through biological intervention. But the brain consists of complex, interactive networks, and unintended consequences could easily occur. Moreover, memory is woven into our individuality. Altering our memory processes therefore risks altering us fundamentally. We may not be able to resist opening this neuroscientific Pandora's Box, John Gabrieli writes, but we must proceed with all the wisdom we can muster.

Amnesia↗
PubMed2005

Barriers to detecting and treating hypercholesterolaemia in patients with ischaemic heart disease: primary care perceptions.

BACKGROUND: Treating hypercholesterolaemia in patients with ischaemic heart disease can significantly reduce vascular deaths and events. Many such patients, however, do not receive effective treatment for hypercholesterolaemia. AIM: To ascertain the barriers to the detection and treatment of hypercholesterolaemia in patients with ischaemic heart disease as seen by primary care teams. DESIGN OF STUDY: Qualitative study using the nominal group technique. SETTING: General practice teams in the North Thames region of the Medical Research Council General Practice Research Framework. METHOD: The main outcomes measures used were identification of the barriers to the detection and treatment of hypercholesterolaemia together with relative rankings. RESULTS: Fourteen individual barriers were identified. The main barriers were: organisational barriers within general practices; confusing and conflicting guidelines from external sources; errors and omissions by GPs; communication problems at the interface between secondary and primary care; and reluctance by patients to take medication. CONCLUSIONS: The reasons for suboptimal detection and treatment of hypercholesterolaemia are complex and act at various levels. Interventions to improve the management of this condition must address these barriers in order to be successful.

Attitude of Health Personnel↗
PubMed2005

Three-dimensional ultrasonography and power Doppler in ovarian cancer screening of asymptomatic peri- and postmenopausal women.

AIM: To determine whether introducing three-dimensional (3D) ultrasonography with power Doppler facilities as a secondary screening test, preceded by annual transvaginal grayscale ultrasonography (TVUS) (followed by transvaginal color Doppler (TVCD) in selected cases) as a primary screening test for ovarian cancer improves the accuracy of ovarian cancer screening studies. METHODS: Annual TVUS was performed on 3,201 peri- and postmenopausal asymptomatic women aged > or =50 years from March 1, 2001 to June 30, 2003. Cystic ovarian lesions in perimenopausal women were routinely reevaluated by TVUS and TVCD at 4-6 week intervals to avoid unnecessary surgical intervention for physiological cysts. Any multiloculated, complex or solid ovarian mass, as well as persistently cystic mass >5 cm in diameter, in which the echo architecture and/or blood flow pattern was not highly suggestive of a benign histology, was categorized malignant. In these cases, TVUS and TVCD findings were obtained in no more than 2 weeks and supplemented by secondary screening, including 3D ultrasonography, and 3D power Doppler, in combination with serum CA 125 determination. After detailed ultrasonographic examination, surgical removal of the tumor and pathohistological classification were completed. RESULTS: Twenty-five patients (0.8%) with persisting ultrasonographic abnormalities after primary and secondary screening underwent surgery to remove the ovarian tumor. Five epithelial ovarian cancers were detected: 3 stage IA, 1 stage IB, and 1 stage IC. Three stage I patients had a palpable abnormality on clinical examination. Furthermore, in three patients with stage I disease, CA 125 serum value was elevated (> or =35 U/mL). Three-dimensional ultrasonography and power Doppler, as well as TVUS findings were indicative of malignancy in all 5 patients with stage I ovarian cancer, whereas TVCD finding was false-negative in 2 patients with stage I disease. Screening test (primary+secondary screening) had the sensitivity of 100%, specificity of 99.4%, positive predictive value of 20%, and negative predictive value of 100%. CONCLUSION: Application of 3D ultrasonography and power Doppler imaging in patients with "positive" standard ultrasound tests (annual TVUS, followed by TVCD in selected cases) represents a novel approach for the early and accurate detection of ovarian cancer through screening.

Aged↗
PubMed2006

[Vascular involvement in thoracic outlet syndrome].

Vascular involvement in thoracic outlet syndrome is beside neurological symptoms one of the possible manifestations of this disease, typically affecting young, otherwise healthy individuals. The most frequent vascular manifestations of the thoracic outlet syndrome include symptoms related to the venous hypertension with possible outfall to the deep vein thrombosis. Arterial involvement is mostly revealed by the presence of ischemic symptoms. Several key points for the correct diagnosis should be stressed out. They include specific events in patient history, especially previous effort or trauma of the affected upper extremity, typically unilateral. Arterial manifestations are characterized by the absence of ischemic symptoms in other localisations. Deep vein thrombosis occurs in the absence of other distinct precipitating factor and/or hypercoagulable state. Some provocative manoeuvres may help in correct diagnosis assessment, especially in the connection with duplex ultrasound examination. Endovascular procedures both in venous and arterial thoracic outlet syndrome became rather a part of therapeutical process while their role in diagnosis decreasing. The treatment of thoracic outlet syndrome patients is currently evolving into an interdisciplinary approach integrating angiologists, interventional angiologists and vascular surgeons. This complex multidisciplinary approach improves long term results and quality of life of these patients.

Arm↗
PubMed2006

Design issues and priorities in team and nonpharmacological arthritis care research.

Nonpharmacologic and team care research present unique design challenges. Nonpharmacologic care by nature is multifaceted and complex. Rarely do patients receive an intervention in isolation. The delivery of a single or group of interventions can be provided by one provider but is frequently provided by teams. Therefore, it is imperative that clinical researchers design studies that evaluate single and multimodal interventions as well as studies that best reproduce the team model of service delivery to accurately examine interventions. While it is well accepted that the research question drives the design, it is imperative to recognize that certain aspects of nonpharmacologic and team care restrict the implementation or effectiveness of specific design components. For example, as patients are required to actively engage in lifestyle changes, double-blinding cannot be employed. In addition, there is no accepted operational definition of team care in arthritis. It is important to keep in mind the characteristics of these interventions in the selection of a research design and develop strategies to best examine these interventions. Combining aspects of randomized controlled trials with qualitative methods is one technique to enrich data collected on these interventions. Certain features of pharmacovigilance studies may also serve as an alternative model. The use of national or regional registries for longterm clinical followup as seen in orthopedic surgery may prove to be applicable in the design of studies for evaluation of team care. Our article will discuss issues related to the design and synthesis of arthritis care research, and the role of patients in the design of clinical trials; describe collaborative international activities furthering team and nonpharmacological arthritis care research; and identify research activities that may influence future practice and the health of people with arthritis.

Arthritis↗
PubMed1991

Prevention of pedestrian injuries to children: effectiveness of a school training program.

Pedestrian injuries are a complex problem for which no single intervention will be completely effective. One component of a community-wide program, training of schoolchildren in street-crossing skills, is evaluated. The program targeted public school students in grades K through 4 with an eight-session training program by a single teacher, cross-age teaching, videotape feedback, and in 1990 parent-child activity workbooks. Children's street crossing was observed pretraining and posttraining and graded on four behaviors: WALKING on sidewalk/shoulder vs in the street; STOPPING at the curb; LOOKING L-R-L before crossing; KEEP LOOKING while crossing. Analysis was conducted on matched pairs in which observations pretraining were compared with those posttraining on same child. Observations were completed on 137 children in 1989 and 92 in 1990. Nearly all children walked on the side of the road; however, fewer than 50% of children STOPPED, 25% LOOKED, and fewer than 20% KEPT LOOKING before training. Training did not improve the performance on the first two behaviors in either year, significantly increased LOOKING in 1990, and increased KEEP LOOKING by twofold in 1989 and threefold in 1990. It is concluded that pedestrian skills of children can be improved but that such a program must be part of a broader effort if pedestrian injuries are to decrease.

Accidents, Traffic↗
PubMed1990

Nursing care planning. Overview and application to the patient in shock.

The systematic nursing process is an essential prerequisite for providing effective care for patients in shock. Nurses use assessment skills to identify actual and potential collaborative problems and nursing diagnoses. Once collaborative problems and nursing diagnoses are identified, the nurse develops appropriate individualized patient outcomes and plans care to accomplish the outcomes and resolve the problems. Nursing actions from the three domains may be included in the care plan. The evaluation phase assesses the adequacy of nursing actions in accomplishing the stated goals and returns the process to the stage of assessment. Application of the nursing care planning process to the patient in shock can be somewhat difficult because of the critical nature of the illness, complex assessment data, and rapidly changing interventions. It is indeed a challenge for the critical care nurse to integrate sound principles of nursing care planning into the busy intensive care environment, but the outcome of improved patient care is worth the effort.

Critical Care↗
PubMed1989

[Stuttering in children as a problem of phoniatric outpatient clinics].

Stuttering in young children is an extremely complex phenomenon. On all levels of intervention such as evaluation, differential diagnosis between stuttering and normal disfluency, diagnostic guidance of therapy process or direct and indirect treatment a number of questions arise for which answers have not been yet found. But realizing that the disorder is most difficulty to cure in adults and adolescents prevention or early treatment is essential. So diagnosticians and therapists need a high level of knowledge about the onset, the maintenance and the development of the disorder in every individual case of stuttering in young children. Decisions concerning the indications for diagnostic and therapeutic interventions must not be made by intuition but by professionally balancing the influencing factors such as psycho-social variables or marked deficits in mental, motor or sensory areas of the child's development. We want to demonstrate the different dimensions of the diagnostic and therapeutic process and the amount of professional time and effort which is necessary for the handling the stuttering child and his family.

Diagnosis, Differential↗
PubMed1988

[Acute testicular diseases in children].

The work is based upon an experience with the treatment of 97 patients with acute diseases of the testicles aged from 6 months to 14 years. An analysis of remote results allows to recommend early urgent operative interventions which must be followed by complex antibacterial, desensitizing, antiinflammatory and immunodepressive therapy in the postoperative period.

Acute Disease↗