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PubMedDate not supplied

Radiolabelled unprocessed bran: validation of a practical labelling technique and evaluation of gastrointestinal transit profiles in health.

Using a radiolabelled bran preparation, a large field of view gamma-camera and a computer, a method has been developed to define and analyse the gastrointestinal transit profile of solids. Unprocessed bran, labelled with technetium (99mTc) sulphur colloid is incorporated into biscuits cooked in a microwave oven. With this preparation, less than 3.4% of the isotope dissociated from the bran in a gastric milieu, and more than 90% of recovered radionuclide activity, were retained with the solid phase during small intestinal transit in subjects with stable ileostomy function. A normal range for gastric emptying (GE), small intestinal transit (IT) and colonic filling (CF) was established in 15 healthy volunteers. Anterior and posterior images were taken until all isotope was present in the colon. Using regions of interest for the stomach and colon, decay corrected geometric mean curves for GE and CF were generated. GE was characterized by a lag phase followed by a linear emptying phase. The GE profile (mean and standard deviation) was described by 'power exponential' parameters of half-emptying time (1.6 +/- 0.4 h) and beta (1.5 +/- 0.2). The IT time was 3.9 +/- 1.5 h. The onset of CF was determined visually (4.1 +/- 1.5 h), and the time of 50% CF filling was determined from the colonic filling curve (5.5 +/- 1.4 h). This technique should provide a useful, practical, clinical and research test to study the pathophysiology and pharmacology of intestinal motor disorders.

Adult↗
PubMed2004

Health systems in transition in Central and Eastern Europe.

On 1 May 2004, eight former communist countries of Central and Eastern Europe joined the European Union (EU). THis created a range of challenges for health policy in the new member states. On top of issues relating to the health of their populations, their economic situation, and the changing nature of healthcare that affects all countries, the process of acceding to the EU requires them to adhere to the accumulated boyd of European law, some of which has implications, directly or indirectly, for health policy. This paper examines these challenges and the responses being developed to them. While the countries have much in common, in particular the shift from the former model of healthcare financing to a more pluralistic model, often based on health insurance, there is also considerable diversity, as each is using different policy options to achieve the same broad objectives. While these countries have much in common, not least the experience of EU accession, they also have considerable flexibility to pursue the systems that they choose. The challenge is to enable a process of homogenous model that ignores their important systems of healthcare being adopted by their neighbours in this region and to the models existing in the countries of Western Europe, but instead should be looking to the systems that they will have to put in place to meet the specific health needs of their own populations, which are different from those in other parts of Europe as well to meet the challenges of the future.

Delivery of Health Care↗
PubMed1997

Health status during the transition in Central and Eastern Europe: development in reverse?

This paper reports on a study of the cross-national trends in health status during the economic transition and associated health sector reforms in Central and Eastern Europe (CEE). The central premise is that before long-run gains in health status are realized, the transition towards a market economy and adoption of democratic forms of government should lead to short-run deterioration as a result of: (i) reduction in real income and widening income disparities; (ii) stress and stress-related behaviour; (iii) lax regulation of environmental and occupational risks; and (iv) breakdown in basic health services. Analysis focused on three broad indicators of health status: life expectancy at birth, infant mortality rate and the probability of dying between the ages of 15 and 65 years, shown by the notation '50q15'. The study revealed significant new information about health status and the health sector which could not have been obtained without a proper cross-national study. Infant mortality rates in former socialist economies (FSE) follow the global trend, declining as per capita income rises. However, rates are lower than would be predicted given their income levels. Despite declining infant mortality, life expectancy at birth in the former socialist economies decreases as per capita income rises, in marked contrast to global trends. This is because rising income level is associated with greater probability of death between the ages of 15 and 65: the wealthier the society, the less healthy is its population, particularly for its males. Causes of death in the FSE follow global trends: higher death rates due to infectious and parasitic diseases in poorer countries, and higher death rates due to chronic diseases in wealthier countries. However, age-standardized death rates for chronic diseases generally associated with unhealthy lifestyles and environmental risk factors are very high when compared with wealthier established market economies (EME). Policies and procedures which alter the effectiveness of health services have had a demonstrable but mixed impact on health status during the early phase of transition. Effective preventive health strategies must be formulated and implemented to reverse the adverse trends observed in Central and Eastern Europe.

Adolescent↗
PubMed1998

Measuring change in health in general practice: a comparison of a simple transition question with the Nottingham Health Profile.

OBJECTIVE: To compare a simple transition question with a standard measure of distress [the Nottingham Health Profile (NHP)] in the measurement of change in health of patients attending general practitioners. SETTINGS AND SUBJECTS: Two hundred and thirty one patients attending for acute or chronic illness, or follow-up consultations in a single general practice. MEASURES: Patients completed the NHP at the consultation and again after 2 weeks. They also completed the transition question after 2 weeks, which asked how the patient felt in comparison with 2 weeks before. In addition, patients in the chronic category were reviewed at 2 weeks by the general practitioner. Analysis sought the level of agreement between the changes in NHP scores and the transition question responses. RESULTS: Levels of correlation between changes in NHP scores and the transition question were low, and for patients with chronic illness correlation was only moderate between the transition question and the general practitioner's assessment. The transition question was less sensitive to deterioration in health. CONCLUSIONS: Caution is required in the interpretation of finding from the use of simple transition questions that ask patients how they feel. Further evaluation of transition questions with different wording and format is required.

Chronic Disease↗
PubMed2001

Macronutrients and health-steps to ameliorating the nutrition transition trap.

Countries that have made the health transition from a communicable disease base to a non-communicable disease base find themselves gripped in an epidemic of wealth created diseases mediated by altered macronutrient intakes, energy intakes and reduction in physical activity. Avoiding the negative impact of the nutrition transition while accepting the positive aspects of the wealth transition can best be achieved by focussing on publicising the benefits of a low fat diet in the context of an active lifestyle. How this is achieved should reflect ecologically sound food production appropriate to national needs. Countries that achieve this will be in the best position to capitalize on the reduction in communicable disease rates without causing a rise in non-communicable disease rates.

Dietary Fats↗
PubMed2006

Changes in primary health care centres over the transition period in Slovenia.

BACKGROUND: Primary health care centres (PHCCs) were a characteristic of the former Yugoslav health care system introduced widely in Slovenia. Transition brought structural changes to health care and the position of the PHCC's was challenged. This paper investigates (i) PHCCs' perception of transition changes in health care, (ii) changes in resources and services, and (iii) changes in the relationships between PHCCs and new primary health care providers. METHODS: We mailed a self-administered questionnaire with 42 questions divided into 8 chapters and related to the period between 1990 and 2000 to all 65 PHCCs in Slovenia. Questions were of three types, grouped according to the aspects we were trying to explore: perceived changes, actual changes and relations with new providers. RESULTS: We obtained 57 questionnaires representing PHCC catchment areas covering 93.7% of the Slovenian population. Municipalities' position versus PHCCs was reinforced but their role remains ambiguous. The number of employees was reduced by one third, capital investments are still ongoing, but the scope and volume of services has shrunk. Relations with the Health Insurance Institute of Slovenia (HIIS) were considered controversial while the influence of the public providers' association is perceived as marginal. CONCLUSIONS: PHCCs have survived the transition both structurally as well as functionally. However, an unstructured approach to system changes in primary care, a poorly managed process of introducing private provision, and a monopoly position of the HIIS affected their situation. The challenges for the future will be in preserving their public health functions, in increasing efficiency and in establishing clearly defined relations with private providers.

Forecasting↗
PubMed1998

Urban health care in transition: challenges facing Los Angeles County.

The authors examine the Medicaid Section 1115 Demonstration Project currently underway in Los Angeles County. The waiver was designed as part of a response to a financial crisis the Los Angeles County Department of Health Services (LACDHS) faced in 1995. It provides financial relief to give the county time to restructure its system for serving the medically indigent population. Los Angeles County's goal is to reduce its traditional emphasis on emergency room and hospital care by building an integrated system of community-based primary, specialty, and public health care. This case study describes activities completed through the spring of 1997, approximately 1 year after the waiver was approved.

Community Health Services↗