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PubMed1992

[Creation of a planned autologous transfusion unit in a hospital distinct from a transfusion center].

Autologous blood predonation now widely used for programmed surgery has been recently regulated by a law from january 9 1992. It establishes that the procedure must be performed under the responsibility of an accredited blood transfusion center. This work discloses that the establishment of an autotransfusion unit in a hospital endowed with an active surgical program is feasible, the major objective being improvement of the quality of life of elderly patients with invalidating diseases. We report the one year experience of a collaboration between the Braine-l'Alleud-Waterloo hospital and the Red Cross Erasme-Brabant Wallon blood transfusion center. Eighty patients enrolled in programmed surgery consisting mostly in orthopedic surgery have given 187 units of packed red blood cells and fresh frozen plasma. Sixty two patients (83%) were transfused solely with autologous blood. Tolerance was excellent as only 4 slight malaise episodes were observed. Our study also indicates that programmed predonation should be proposed mainly to patients for whom the prescribed blood is effectively transfused. Creation of such autotransfusion units in hospitals distinct from a blood transfusion center is feasible with the deep collaboration between physicians in charge of the patients, the hospital laboratory and the blood transfusion center.

Adult↗
PubMedDate not supplied

Prevalence of the metabolic syndrome and overweight among adults in China.

BACKGROUND: The metabolic syndrome and obesity are major risk factors for cardiovascular disease. Little information exists on the prevalence of the metabolic syndrome in China. We aimed to provide up-to-date estimates of the prevalence of the metabolic syndrome and overweight in the general adult population in China. METHODS: We did a cross-sectional survey in a nationally representative sample of 15,540 Chinese adults aged 35-74 years in 2000-01. Metabolic syndrome was defined according to guidelines from the US National Cholesterol Education Program. Overweight was defined as body-mass index of 25.0 kg/m2 or greater. FINDINGS: The age-standardised prevalence of metabolic syndrome was 9.8% (95% CI 9.0-10.6) in men and 17.8% (16.6-19.0) in women. The age-standardised prevalence of overweight was 26.9% (25.7-28.1) in men and 31.1% (29.7-32.5) in women. The prevalence of the metabolic syndrome and overweight was higher in northern than in southern China, and higher in urban than rural residents. INTERPRETATION: Our results indicate that a large proportion of Chinese adults have the metabolic syndrome and that overweight has become an important public health problem in China. These findings emphasise the urgent need to develop national strategies for the prevention, detection, and treatment of overweight and the metabolic syndrome, to reduce the societal burden of cardiovascular disease in China.

Adult↗
PubMed1997

Comparison of metabolic control in a cross-sectional study of 2,873 children and adolescents with IDDM from 18 countries. The Hvidøre Study Group on Childhood Diabetes.

OBJECTIVE: To obtain an estimate of the current level of metabolic control in children and adolescents with IDDM, the Hvidøre Study Group on Childhood Diabetes decided to establish a formal collaboration among countries to gather and exchange data for comparative purposes. RESEARCH DESIGN AND METHODS: This cross-sectional non-population-based survey involved 22 pediatric departments from 18 countries in Europe, Japan, and North America. Blood samples and information were collected from March through August 1995 on 2,873 children who were born in 1977 or later and seen in the outpatient clinics. HbA1c levels were determined once and analyzed centrally (normal range, 4.4-6.3%; mean, 5.4%). Year of birth, sex, duration of diabetes, height, body weight, insulin regimen, and number of episodes of severe hypoglycemia during the past 3 months were recorded. RESULTS: Average HbA1c was 8.6 +/- 1.7%, but varied significantly (P < 0.0001) between centers. Hypoglycemia resulting in unconsciousness and/or seizures was related to younger age (0-8 years) and lower HbA1c level. The incidence, based on the 3-month period, was 22 per 100 patient-years. Sixty percent of the children (n = 1,707) had two injections daily, while 37% (n = 1,071) were on three or more. HbA1c increased during maturation for both sexes. No difference in glycemic control was found among adolescents treated with two, three, and four or more daily injections. Adolescents on four or more injections received significantly (P < 0.001) more insulin. Girls on four or more injections had significantly (P < 0.01) higher BMI than girls on twice-daily insulin. CONCLUSIONS: In the participating centers with a multidisciplinary team, only one third of the patients had an HbA1c level of < 8%.

Adolescent↗
PubMed1996

Psychiatric assessment instruments developed by the World Health Organization.

Over the past 30 years the World Health Organization (WHO) has produced a number of assessment instruments intended for national and cross-cultural psychiatric research. WHO instruments have been tested and used in many collaborative studies involving more than 100 centres in different parts of the world. This article reviews the main WHO instruments for the assessment of (a) psychopathology, (b) disability, quality of life and satisfaction, (c) services, and (d) environment, and risks to mental health. The principles used in the development of WHO instruments, their translation and their use across cultures and settings are discussed.

Cross-Cultural Comparison↗
PubMed2003

Measurement and determinants of the natural history of liver fibrosis in hepatitis C virus infection: a cross sectional and longitudinal study.

INTRODUCTION: The rate of development of liver fibrosis in hepatitis C virus (HCV) infection varies between individuals. This accounts for the variation in duration of progression to cirrhosis. The aims of this study were: (1) to determine whether fibrosis progresses linearly through the grading scales and (2) to identify factors which influence the rate of fibrosis. METHODS: HCV infected patients who had undergone at least one liver biopsy were identified. Biopsies were scored using the modified HAI (Ishak) and METAVIR systems, which were compared. Patients were treatment naïve at first biopsy. Demographic features were examined for their relationship to fibrosis rate (defined as fibrosis stage/infection duration) using univariate and multivariate analysis. A subgroup of patients with two biopsies was examined to test the assumption that fibrosis progresses in a linear fashion. RESULTS: A total of 917 patients were included. Male sex (p<0.00001), older age at infection (p</=0.00001), and viral genotype non-1 (p=0.005) were all associated with a rapid rate of fibrosis. On multiple linear regression they accounted for 29.5% of the variability in fibrosis rate (r(2)=0.295). METAVIR and Ishak scores were highly correlated (r=0.935, p<0.0001). In 137 patients who had two biopsies, the predicted probability for an increase of 1 on the fibrosis score was too low to assess linearity. CONCLUSIONS: Demographic features account for a minority of fibrosis rate variability. The Ishak and METAVIR scoring systems are equivalent. Linearity of fibrosis progression cannot be assessed in biopsies only a few years apart.

Adult↗
PubMed2003

Antithrombotic drugs in secondary stroke prevention among a community dwelling older population.

BACKGROUND: Patients who suffer a cerebrovascular event are at high risk of a recurrence. Secondary prevention is crucial in reducing the burden of cerebrovascular disease. OBJECTIVE: To estimate the percentage of stroke survivors receiving antiplatelet or anticoagulant drugs and to identify factors associated with such treatment. DESIGN: Cross sectional retrospective cohort study. METHODS: Data were analysed from a large collaborative observational study, the Italian "silver network" home care project, which collected data (from 1997 to 2001) on patients admitted to home care programmes (n = 5372). Twenty two home health agencies participated in evaluating the implementation of the minimum dataset for home care (MDS-HC) instrument. For the present study, 648 individuals with a diagnosis of stroke were selected and the initial MDS-HC assessment reported. RESULTS: 70% of stroke survivors did not receive any antiplatelet or anticoagulant drugs (95% confidence interval (CI), 66.5 to 73.5). Among all age categories, aspirin and ticlopidine were the two most commonly prescribed drugs. Living alone (odds ratio (OR), 0.49 (95% CI, 0.24 to 0.89)), dependency in activities of daily living (0.66 (0.40 to 0.99)), cognitive impairment (0.58 (0.38 to 0.86)), and low educational level (0.58 (0.34 to 0.98)) were associated with a reduced likelihood of receiving secondary stroke prevention treatment. Cardiac arrhythmias, coronary artery disease, heart failure, and peripheral vascular disease were associated with the use of antiplatelet or anticoagulant treatment. CONCLUSIONS: Negative attitudes among physicians with respect to secondary stroke prevention are prevalent and reinforce the need for increased awareness of existing data on the risks and benefits for elderly individuals. Social problems and functional impairment may be issues concerning physicians when deciding whether or not the risks of treatment exceed the benefit.

Activities of Daily Living↗
PubMed2005

Comparison of flat and steep rigid contact lens fitting methods in keratoconus.

PURPOSE: The purpose of this article is to compare the safety and efficacy of flat- and steep-fitting rigid contact lenses in keratoconus. METHODS: The Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study is a 16-center observational study. Cross-sectional results at baseline were generated for 1091 subjects with longitudinal results from the 871 subjects who completed 8 years of follow up. RESULTS: Of the 761 rigid contact lens-wearing patients at baseline, 41% had a scar at baseline compared with 24% of the nonrigid contact lens wearers (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.35-3.43; p = 0.001). Eighty-seven percent were fitted with flat-fitting lenses, whereas 13% were fitted with steep-fitting lenses. Rigid lens fitting method was also associated with incident corneal scarring. A greater proportion of the corneas wearing flat-fitting contact lenses were scarred (43% compared with 26% for the steep-fitted eyes; OR,= 2.19; 95% CI, 1.37-3.51; p = 0.001). After controlling for corneal curvature, the association of rigid contact lens fit and corneal scarring at baseline did not persist (adjusted OR, 1.20; 95% CI, 0.70-2.06; p = 0.52). Thirty-two percent of unscarred eyes at baseline fitted flat had developed an incident corneal scar by the eighth year follow-up visit compared with 14% of eyes fitted steep (OR, 2.93; 95% CI, 1.34-6.42; p = 0.007). CONCLUSIONS: The data reported here indicate that, after controlling for disease severity in the form of corneal curvature, keratoconic eyes fitted with a rigid contact lens resulting in an apical touch fluorescein pattern did not have an increased risk of being scarred centrally at baseline. This "natural history" sample cannot determine causal proof that one method of fitting lenses is safer than another. To achieve this, a randomized clinical trial is needed.

Contact Lenses↗
PubMed2004

Marker-evaluated selection in rice: shifts in allele frequency among bulks selected in contrasting agricultural environments identify genomic regions of importance to rice adaptation and breeding.

Conventional methods for quantitative trait locus (QTL) mapping require the selection of particular traits to be measured based on assumptions as to their importance. We have tested an alternative approach for the location of QTLs-marker-evaluated selection-that makes no prior assumptions as to which traits are important. The results of phenotype selection were evaluated in the products of modified bulk-population breeding that was replicated across a range of rice ecosystems. Selection was carried out in close collaboration with farmers in bulk populations that were all derived from a cross between an Indian upland variety (Kalinga III) and a high-yielding semi-dwarf variety (IR64).Twenty-seven diverse bulks were produced that were screened with molecular markers in order to determine whether shifts could be detected in marker allele frequency as a result of selection and if such changes varied by genomic region across ecosystems. Marker loci linked to important traits for adaptation to specific environments were identified without making any prior assumptions about which traits might be important. Genomic regions from Kalinga III were strongly selected in the upland environments and regions from IR64 in the lowland ones.However, exceptions occurred where the upland parent contributed positively to lowland adaptation and vice versa. The results can be used as a basis for the development of second-cycle varieties, using marker-assisted selection to produce genotypic ideotypes for specific target environments. The very strong selection for genomic regions from the adapted parents of the wide(upland x lowland) cross indicates that, in non-marker-assisted breeding, where genetically distant parents have been used, modified backcross breeding should be efficient. A single backcross to the adapted parent for aspecific ecosystem will result in a higher frequency of segregants with the desired high genetic contribution from the adapted parent.

Acclimatization↗
PubMed2001

Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.

BACKGROUND: The effect of dietary composition on blood pressure is a subject of public health importance. We studied the effect of different levels of dietary sodium, in conjunction with the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in vegetables, fruits, and low-fat dairy products, in persons with and in those without hypertension. METHODS: A total of 412 participants were randomly assigned to eat either a control diet typical of intake in the United States or the DASH diet. Within the assigned diet, participants ate foods with high, intermediate, and low levels of sodium for 30 consecutive days each, in random order. RESULTS: Reducing the sodium intake from the high to the intermediate level reduced the systolic blood pressure by 2.1 mm Hg (P<0.001) during the control diet and by 1.3 mm Hg (P=0.03) during the DASH diet. Reducing the sodium intake from the intermediate to the low level caused additional reductions of 4.6 mm Hg during the control diet (P<0.001) and 1.7 mm Hg during the DASH diet (P<0.01). The effects of sodium were observed in participants with and in those without hypertension, blacks and those of other races, and women and men. The DASH diet was associated with a significantly lower systolic blood pressure at each sodium level; and the difference was greater with high sodium levels than with low ones. As compared with the control diet with a high sodium level, the DASH diet with a low sodium level led to a mean systolic blood pressure that was 7.1 mm Hg lower in participants without hypertension, and 11.5 mm Hg lower in participants with hypertension. CONCLUSIONS: The reduction of sodium intake to levels below the current recommendation of 100 mmol per day and the DASH diet both lower blood pressure substantially, with greater effects in combination than singly. Long-term health benefits will depend on the ability of people to make long-lasting dietary changes and the increased availability of lower-sodium foods.

Blood Pressure↗
PubMed1994

Developing countries' health expenditure information: what exists and what is needed?

In the past decade, the scarcity of financial resources for the health sector has increasingly led countries to take stock of national health resources used, review allocation patterns, assess the efficiency of existing resource use, and study health financing options. The primary difficulties in undertaking these analyses have been 1) the lack of information on health expenditures and 2) not using existing information to improve the planning and management of health sector resources. The principle sources of available health expenditure information are reported by organizations such as the World Bank, WHO, UNICEF and OECD. Special studies and non-routine information are a second major source of information. This existing data has a number of difficulties, including being sporadic, inconsistency, inclusion of only national level public expenditure, high opportunity and maintenance costs, quantitative and qualitative differences across countries, and validity and interpretability problems. Reliable health expenditure data would be useful not only for in-country, national purposes, but also for cross-national comparisons and for development agencies. Country uses of health expenditure data include policy formulation and planning and management, while international uses would facilitate examination of cross-national comparisons, reviews of existing programmes and identification of funding priorities. Collaborative efforts between countries and international development agencies, as well as between agencies, are needed to establish guidelines for health expenditure data sets. This development must ensure that the resulting information is of direct benefit to countries, as well as to agencies. Results of such collaborative efforts may include a set of standardized methodologies and tools; standardized national health accounts for developing countries; and training to enhance national capabilities to actively use the information. The opportunities for such collaboration are unique with the issuance of the World Development Report 1993, to build on this work in clearly identifying what is needed and proposing a standardized data set and the tools necessary to regularly and economically gather such data.

Data Collection↗
PubMed2003

Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial.

BACKGROUND AND PURPOSE: Previous studies suggest that undernourished patients with acute stroke do badly. The data, however, are not robust. We aimed to reliably assess the importance of baseline nutritional status as an independent predictor of long-term outcome after stroke in a large prospective cohort enrolled in the Feed Or Ordinary Diet (FOOD) trial, a multicenter randomized trial evaluating various feeding policies. METHODS: Patients admitted to hospital with a recent stroke were enrolled in the FOOD trial. Data on nutritional status and other clinical predictors of outcome were collected at trial entry. At 6 months, the coordinating center collected data on survival and functional status (modified Rankin Scale). Outcome assessment was done by researchers blinded to baseline assessments and treatment allocation. RESULTS: Between November 1996 and November 2001, 3012 patients were enrolled, and 2955 (98%) were followed up. Of the 275 undernourished patients, 102 (37%) were dead by final follow-up compared with only 445 (20%) of 2194 patients of normal nutritional status (odds ratio [OR], 2.32; 95% CI, 1.78 to 3.02). After adjustment for age, prestroke functional state, and stroke severity, this relationship, although weakened, still held (OR, 1.82; 95% CI, 1.34 to 2.47). Undernourished patients were more likely to develop pneumonia, other infections, and gastrointestinal bleeding during their hospital admission than other patients. CONCLUSIONS: These data provide reliable evidence that nutritional status early after stroke is independently associated with long-term outcome. It supports the rationale for the FOOD trial, which continues to recruit and aims to estimate the effect of different feeding regimes on outcome after stroke and thus determine whether the association observed in this study is likely to be causal.

Aged↗
PubMed2006

[Effect of flour folic acid fortification on the incidence of cranio encephalic congenital defects].

BACKGROUND: In Chile, flour is fortified with folic acid since 2000, and the incidence of neural tube defects has decreased. Cranio-encephalic congenital defects (CECD) have a wider clinical scope, includind classical neural tube defects (NTD) such as anencephalia and acrania, but also incorporating other defects. Therefore, the effects of folic acid fortification on the incidence of CECD could be different. AIM: To study the effect of folic acid fortification on the incidence of CECD. MATERIAL AND METHODS: All prenatal diagnoses of CECD and cases registered locally in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) were reviewed. The obtained data were crossed with all death certificates of newborns or stillborns of more than 500 g in the Sixth Region, in Central Chile. All cases were classified again in four subtypes, according to their phenotype. The incidences of all subtypes prior (1996-2000) and after folic acid supplementation (2001-2004), were compared. RESULTS: Between 1996 and 2004, there were 64 cases of CEDC among 109,176 infants born alive. The global rate was 8.86 per 10,000 born alive in the period prior to fortification and 3.03 per 10,000 born alive after fortification. Comparing both periods, there was a 66% reduction in all CECD and a 77 and 100% reduction in subtypes A and B of CECD, respectively (p <0.05). No significant reductions in type C and D CECD, were observed. CONCLUSIONS: After the start of flour folic acid fortification, there was a global reduction in the incidence of CECD. However, only types A and B CECD, supposedly more responsive to folic acid, were reduced.

Anencephaly↗
PubMed2005

[Hospital discharge information as a communication tool].

BACKGROUND: The main objective of the list patient health reform has been to improve the quality of local medical service. In European healthcare systems, there has been a need for coordination between primary and secondary care. It has been claimed that the communication between GPs and specialised health care is insufficient, particularly for patients with an extended need of care. MATERIAL AND METHODS: Data on collaboration and satisfaction with specialised health services was collected in a cross-sectional questionnaire survey comprising all Norwegian GPs in 2004 (N = 633); the response rate was 48%. RESULTS: Median delay in receiving patient information was one week or more for inpatient and outpatient treatment. Overall, GPs were satisfied with the hospitals' discharge reports, except for patients needing extended follow up by GPs after discharge. In these patients, GPs more frequently needed to contact the hospital because of insufficient data or unacceptable delays. Female GPs were less satisfied with information services in patients with increased needs. There were also geographical differences in satisfaction. INTERPRETATION: In patients with an increased need for follow up, GPs are less satisfied with hospital information service.

Attitude of Health Personnel↗
PubMed2006

Developing a musculo-skeletal screening survey for Indigenous Australians living in rural communities.

INTRODUCTION: Indigenous Australians living in rural communities experience high levels of musculoskeletal conditions that significantly impair their daily activities. Aboriginal health workers (AHWs) have a close understanding of their communities' needs and play a central role in the assessment and management of these conditions. To assist in the musculoskeletal assessment process a screening survey was collaboratively developed, trialled and evaluated for use by AHWs. METHODS: A cross-sectional survey was developed following discussions with key community informants, and a literature review for relevant survey instruments. It was piloted before being administered by AHWs and the findings compared with those of a clinical assessment conducted by musculoskeletal health professionals. The participants included 189 members of an Australian rural Indigenous community. RESULTS: The screening survey achieved face and content validity. It provided high sensitivity (above 70%) and moderately high specificity (above 60%) for measuring musculoskeletal conditions in this community. It did not achieve high enough Kappa scores when measuring agreement between the screening tool and clinical assessment. A significant correlation was, however, obtained between the most prevalent musculoskeletal condition and between reported overall pain as assessed by AHWs and chiropractors. CONCLUSIONS: The screening survey has applicability in this community and has the potential to be adapted in similar settings. Incorporating a basic range of motion and palpation assessment to localise painful anatomical sites may help to further improve the sensitivity and specificity of this instrument.

Adult↗
PubMed1993

Patient-focused care.

The trend away from a departmental focus and toward "patient-focused" care in hospitals is described; advantages of and barriers to such a change and its effects on pharmacy are discussed. Patient-focused care is characterized by decentralization of services, cross-training of personnel from different departments to provide basic care, interdisciplinary collaboration, various degrees of organizational restructuring, use of "clinical pathways"--recommended components of care for patients with a particular diagnosis, simplification and redesign of work to eliminate steps and save time (e.g., providing care according to predetermined protocols and charting only exceptions to the protocol), and increased involvement of patients in their own care. Its objectives are to use nonclinical and clinical staff more effectively and to improve patients' perceptions of the quality of care and staff members' job satisfaction. It is unrealistic to expect quick reductions in hospital costs through patient-focused care, and workers will worry about job security if an institution overemphasizes this aspect. A 1993 survey of 311 hospitals found that almost half had or planned to have patient-focused care projects. Adoption of patient-focused care projects may be slowed by workers' fear of new responsibilities and new reporting relationships. However, not all patient-focused care models involve radical organizational changes, and reorganizations can be such that pharmacy staff members are still connected to the pharmacy department even if they are supervised by a nonpharmacist. In some institutions patient-focused care projects have given pharmacy its first opportunity for decentralization.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital-Patient Relations↗