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PubMed1999

Chronic bronchitis and chronic obstructive pulmonary disease: Finnish National Guidelines for Prevention and Treatment 1998-2007.

1. A national recommendation for the promotion of prevention, treatment and rehabilitation in relation to chronic bronchitis and COPD from 1998 to 2007 has been prepared on the basis of extensive collaboration by order of the Ministry of Social Affairs and Health. The Programme needs to be revised as necessary, because of rapid developments in medical knowledge, and in drug therapy in particular. 2. COPD is a disease characterized by slowly progressing, irreversible airways obstruction. Over 5% of the population suffer from symptomatic forms of the disease. It is estimated that a further 5% of the population may suffer from latent COPD. Most patients (75%) suffer from mild forms of the disease. The disease is often preceded by chronic bronchitis. A total of 400,000 Finns suffer from chronic bronchitis or COPD. Occurrence of these diseases in future will be particularly affected by decreased smoking by men, increased smoking by the young and by women, and aging of the population. 3. In 1997, the annual treatment costs of chronic bronchitis and COPD were estimated to be FIM 1.5 thousand million, total costs FIM 5 thousand million. Without intensification of measures to prevent and treat the diseases, costs will rise significantly. Costs arising from severe COPD (5% of patients with COPD) account for roughly 65% of costs overall and are primarily related to hospitalizations. 4. The goals of the Programme for the Prevention and Treatment of Chronic Bronchitis and COPD are as follows: (a) to decrease the incidence of chronic bronchitis; (b) to ensure that as many patients as possible with chronic bronchitis recover; (c) to maintain capacity for work and functional capacity of patients with COPD; (d) to reduce the percentage of patients with moderate to severe COPD; (e) to decrease the number of hospitalization days of COPD patients by 25% overall; and (f) to decrease annual costs per patient. 5. The following means are suggested for achieving the goals: (a) reduction in smoking; (b) reduction in work-related and outdoor air pollutants and improvement of quality of indoor air; (c) enhancement of knowledge about risk factors and treatment of the diseases is in key groups; (d) promotion of early diagnosis and active treatment, in smokers in particular; (e) improvement of guided self-care; (f) early commencement of rehabilitation, individual planning and implementation, primarily as an element in treatment; and (g) encouragement of scientific research. 6. COPD and exacerbation of its symptoms can be prevented through choices relating to life habits, such as not smoking, maintaining good general condition, and protection against exposure to dusts. The Programme gives examples of such measures and appeals to various authorities and voluntary organizations to increase their cooperation. Preventive methods should be individualized, and based on due consideration. 7. Chronic bronchitis and COPD should be diagnosed at early stages, and treated appropriately from the outset. Treatment consists of: (a) treatment according to causes, such as stopping smoking and work hygiene; (b) early rehabilitation such as patient education and guided self-care: (c) drug therapy; (d) hospital treatment; and (e) rehabilitation. 8. The hierarchy of referrals in the treatment of COPD should be revised to accord a greater role to the primary health care sector. Good exchanges of information and cooperation between the primary health care and specialized medical care sectors will all be necessary if this hierarchial model is to have the desired effect. 9. Hospital districts and health centres should ensure that different levels of the health-care system are capable of fulfilling the tasks assigned to them appropriately. One specialist in each hospital district should be given charge of prevention and assembly of know-how relating to treatment, and of quality of treatment at regional level. (ABSTRACT TRUNCATED)

Bronchitis↗
PubMed2000

Comparison of ranked segment analysis (RSA) and cup to disc ratio in computer-assisted optic disc evaluation.

PURPOSE: Ranked segment analysis is a new method for evaluation of optic nerve head topography with the Heidelberg Retina Tomograph. This analysis ranks sector measurements around the optic disc and compares these measurements with rank specific significance limits. We evaluated the diagnostic precision of the ranked segment analysis in a large clinical sample and compared with vertical cup/disc ratio measurements. Vertical cup/disc ratio measurements were not corrected for disc size. METHODS: We analysed optic disc images from 153 normal and 75 glaucomatous eyes using the Heidelberg Retina Tomograph (software version 2.01). Ranked segment analyses and vertical cup/disc ratio measurements were obtained from each optic disc image, and ROC curves were plotted. RESULTS: At the 95% specificity level, sensitivity was significantly lower for ranked segment analysis (70%) compared to vertical cup/disc ratio measurements (85%). Almost 30% of the discs in the glaucoma group were classified as normal using the ranked segment analysis. DISCUSSION: Ranked segment analysis yielded unacceptably poor discrimination, in fact, worse than cup/disc ratio with its known clinical limitations Glaucomatous disc damage typically occurs at the vertical poles of the disc. High rank measurements (low sector values) in normal eyes, on the other hand, are more common in the temporal disc sectors. Important spatial information is lost during the ranking procedure. This may partly explain the low sensitivity of the ranked segment analysis observed in our study. The results raise serious concerns regarding the clinical usefulness of ranked segment analysis.

Adult↗
PubMed2006

Federal communication about obesity in the Dietary Guidelines and checkoff programs.

The new Dietary Guidelines for Americans focus on obesity prevention. They recommend increased consumption of whole grains, fruits, vegetables, fish, and low-fat dairy products, within a balanced diet whose total calories have been moderately reduced. Meanwhile, other well-known and well-funded federally sponsored consumer communications promote increased total consumption of beef, pork, and dairy products, including energy dense foods such as bacon cheeseburgers, barbecue pork ribs, pizza, and butter. These latter communications are sponsored by the federal government's commodity promotion programs, known as "checkoff" programs. The programs are established by Congress, approved by a majority of the commodity's producers, managed jointly by a producer board and the U.S. Department of Agriculture, and funded through a tax on the producers. The federal government enforces the collection of more than 600 million US dollars annually in mandatory assessments, approves the advertising and marketing programs, and defends checkoff communication in court as the federal government's own message-in legal jargon, as its own "government speech." Federal support for promoting fruits and vegetables is small by comparison. The checkoff programs recently have become more clearly identified as federal programs. After a recent decision by the U.S. Supreme Court upholding the constitutionality of the checkoff programs, calls for consistency with the Dietary Guidelines may get louder. The current inconsistencies in federal communication undermine the effectiveness of the Dietary Guidelines as an antidote to the shortcomings of the private sector market for information about weight and obesity.

Advertising↗
PubMed2001

The European chemical industry's needs and expectations for workplace exposure data.

Current information on exposure data is characterized by its inconsistent quality and significant gaps. These are particularly apparent amongst small- and medium-sized companies. The European Chemical Industry Council (CEFIC), through its Long Range Research Initiative (LRI), currently is developing a tool which aims, by virtue of it being seen as an integral part of business management software, to collect relevant exposure information across key sectors of the chemical industry.

Chemical Industry↗
PubMed2000

Mental health disorders in children and young people: scope, cause and prevention.

OBJECTIVE: To review the scope and characteristics of mental health disorders in children and young people in Australia; detail some emerging concepts of the causal pathways of mental health disorders in children and young people; and discuss aspects of the prevention of mental health disorders and the promotion of mental health in children and young people. METHOD: An integrated review of selected literature. RESULTS: (i) While as many as one in five Australian children aged from four to 17 have significant mental health problems there remains a need for prevalence estimates in subsections of the population, notably children and young people of Aboriginal and Torres Strait Islander descent; (ii) appropriate studies of gene-environment interaction will require better measurement and developmental exposition of those risk exposures that are known to be on the causal pathway to mental health disorder; and (iii) universal, selective and indicated prevention trials and evaluations directed at anxiety, depression and conduct disorder are needed. CONCLUSION: Preventive intervention and promotion in mental health must entail effective collaboration at national, state and local levels between health, welfare and education sectors. These sectors must be informed by high quality epidemiology and a knowledge of the causal pathways of mental health disorders. Such intervention must also improve the movement of scientific knowledge to political policy on one hand and to praxis on the other. This will require a clear and persistent vision of the urgency, costs and consequences of mental health disorders in children and young people coupled with effective leadership and political resolve.

Adolescent↗
PubMed1996

Double-strand break-induced mitotic intrachromosomal recombination in the fission yeast Schizosaccharomyces pombe.

The Saccharomyces cerevisiae HO gene and MATa cutting site were used to introduce site-specific double-strand breaks (DSBs) within intrachromosomal recombination substrates in Schizosaccharomyces pombe. The recombination substrates consisted of nontandem direct repeats of ade6 heteroalleles. DSB induction stimulated the frequency of recombinants 2000-fold. The spectrum of DSB-induced recombinants depended on whether the DSB was introduced within one of the ade6 repeats or in intervening unique DNA. When the DSB was introduced within unique DNA, over 99.8% of the recombinants lacked the intervening DNA but retained one copy of ade6 that was wild type or either one of the heteroalleles. When the DSB was located in duplicated DNA, 77% of the recombinants were similar to the deletion types described above, but the single ade6 copy was either wild type or exclusively that of the uncut repeat. The remaining 23% of the induced recombinants were gene convertants with two copies of ade6 and the intervening sequences; the ade6 heteroallele in which the DSB was induced was the recipient of genetic information. Half-sectored colonies were isolated, analyzed and interpreted as evidence of heteroduplex DNA formation. The results are discussed in terms of current models for recombination.

Chromosomes, Fungal↗
PubMed1997

U.S. public school enrollment-based health insurance initiatives and America's uninsured.

This article reviews current literature on school enrollment-based health insurance programs underway or pending in the United States. This model of affordable family health insurance delivery was first proposed in a 1988 New England Journal of Medicine Sounding Board article, but only a few states--Arkansas, Florida, New Hampshire, and Texas--have begun public sector-driven programs in the 1990s that use school enrollment as a pooling mechanism to purchase group insurance policies from the private sector. Public support of this model is strong, interest is currently growing, and other states, including North Carolina and Iowa, are exploring or have enacted legislation that supports establishment of school enrollment-based health insurance programs. After summarizing these public-sector initiatives, additional information is presented on uninsuredness in America; risk factors for uninsuredness among children; and national public and private initiatives in child health insurance using eligibility criteria other than or including school enrollment that were examined by the GAO in 1994/95.

Adolescent↗
PubMed2006

Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran.

BACKGROUND: In Iran, there are an estimated 200,000 injecting drug users (IDUs). Injecting drug use is a relatively new phenomenon for this country, where opium smoking was the predominant form of drug use for hundreds of years. As in many countries experiencing a rise in injecting drug use, HIV/AIDS in Iran is associated with the injection of drugs, accounting for transmission of more than two-thirds of HIV infections. This study aimed to: describe the range of characteristics of IDUs in Tehran, Iran's capital city; 2) examine the injecting-related HIV risk behaviors of IDUs, and 3) suggest necessary interventions to prevent HIV transmission among IDUs and their families and sex partners. METHODS: Using rapid assessment and response methods with a qualitative focus, six districts of Tehran were selected for study. A total of 81 key informants from different sectors and 154 IDUs were selected by purposeful, opportunistic and snowball sampling, then interviewed. Ethnographic observations were done for mapping and studying injecting-related HIV risk settings and behaviors. Modified content analysis methods were used to analyze the data and extract typologies of injecting drug users in Tehran. RESULTS: Evidence of injecting drug use and drug-related harm was found in 5 of 6 study districts. Several profiles of IDUs were identified: depending on their socioeconomic status and degree of stability, IDUs employed different injecting behaviors and syringe hygiene practices. The prevalence of sharing injection instruments ranged from 30-100%. Varied magnitudes of risk were evident among the identified IDU typologies in terms of syringe disinfection methods, level of HIV awareness, and personal hygiene exhibited. At the time of research, there were no active HIV prevention programs in existence in Tehran. CONCLUSION: The recent rise of heroin injection in Iran is strongly associated with HIV risk. Sharing injection instruments is a common and complex behavior among Iranian IDUs. For each profile of IDU we identified, diverse and targeted interventions for decreasing sharing behavior and/or its harms are suggested. Some notable efforts to reduce the harm of injecting drug use in Iran have recently been accomplished, but further policies and action-oriented research for identification of effective preventive interventions are urgently needed.

Journal Article↗
PubMed2026

Process evaluation of a nurse-led transitional care model (Cardiolotse) within a randomized controlled trial aiming to improve care coordination for patients with cardiovascular diseases in Germany.

BACKGROUND: Patients with higher age suffering from cardiovascular disease discharged from hospital are at greater risk of readmission within 30 days. We evaluated an innovative care program providing post-discharge support and helping patients to navigate through the healthcare system. This paper reports the findings of the process evaluation of the randomized controlled trial Cardiolotse, a nurse-led transitional care model improving care coordination for patients with cardiovascular diseases in Germany. METHODS: A process evaluation, following the guidelines of the Medical Research Council (MRC) Framework, was performed. Semi-structured interviews with all relevant target groups were conducted to gain more insight about implementation processes. Questionnaires and medical records were used to explore mechanisms of impact and understand how change was produced in the intervention. Qualitative data were analysed using content analysis with deductive and inductive categories. Descriptive statistics and subgroup analyses were utilized to explore quantitative data. RESULTS: Overall, the designed training programme was perceived positively by the study nurses, so called Cardiolotsen (CLs). Patients receiving support by the CLs reported positive satisfaction ratings. Interactions between CLs and patients were reported as trustworthy and reliable. A total of approximately 12,500 contacts were made over the course of the intervention. However, changes in satisfaction scores between intervention and control groups in terms of medical treatment or the interaction between medical health providers involved in the treatment could not be determined. Furthermore, data suggested reach issues with respect to office-based physicians, as regular CL contact could not be achieved with 90% of the participating general practitioners and cardiologists. CONCLUSIONS: The CLs served as an important source of support for the participating patients throughout the intervention. At regular intervals, they checked a patient's health status and their adherence to therapies after discharge. However, the process evaluation identified cross-sectoral communication and information exchange between CLs and office-based physicians as an implementation challenge. TRIAL REGISTRATION: The study was retrospectively registered at German Clinical Trial Register, http://www.drks.de/DRKS00020424 (Trial Registration Number DRKS00020424) on 18 June 2020.

Humans↗
PubMed1993

How do health care education and training professionals learn about the environment?

Preparing for the health care system of the future includes the ability to abstract information from relevant sectors of the environment. This study looked at the way health care educators scan the environment and the relationship of scanning behavior to management style. Results indicate that education and training professionals focus on the regulatory and customer sectors of the environment more than the technological and sociopolitical sectors.

Community Health Planning↗
PubMed2003

A rationale and training agenda for rehabilitation informatics: roadmap for an emerging discipline.

Decreased length of inpatient rehabilitation stay, greater long-term injury survival rates, broader access to information technologies, and the growing role of the Internet create potential for new models of rehabilitation that are more community- and person-centered rather than historically hospital- and provider-centered services. In recent years, information-based rehabilitation technologies have grown rapidly, expanding the possibilities for numerous interventions to promote independent living. These programs have centered primarily on providing rehabilitation health services over a distance ("telerehabilitation"). Telerehabilitation can be conceived as part of a broader approach that includes elements of direct rehabilitation services, service coordination, community resources, and information relay between numerous individuals, service providers, and community members ("rehabilitation informatics"). Because of the complexity of these information types and sectors, this broader conceptual approach of rehabilitation informatics borrows heavily from fields such as adaptive computing, robotics, computer networking, and high-level systems programming. As such, innovation in rehabilitation informatics will require new models of training that span these domains. This paper proposes a rationale for the new field of rehabilitation informatics, and offers a multidisciplinary training model for the next generation of rehabilitation informaticians.

Curriculum↗
PubMed2002

Canadian and the United States' health care systems performance and governance: elements of convergence.

International comparisons of the organisation and performance of health care sectors are increasingly informing policy makers about potential policies relating to health care. Politicians, academics and critics in both the United States and Canada have compared and contrasted the health care systems in the two countries. Public debate tends to emphasise the differences between the US and Canadian health care systems. But, dramatic differences between the organisation and performances of health care systems of the two countries would be surprising given that most elements of divergence have only emerged in the last fifty years, and that health systems tend to be driven by the same basic economic problems. This paper provides an overview of the main economic efficiency issues that must be addressed by health care delivery systems, as well as statistical and related evidence on both input usage and output performance of the two health care systems. While Canada clearly spends less on health care, it is difficult to conclude that Canada has a more efficient health care system than the United States. In particular, the US population puts greater demands on its national health care system owing to a combination of behavioural patterns and socio-economic disparities that contribute to much higher rates of violent accidents, as well as specific diseases and other health problems. Also, the stylized representation of the US system as being 'market-driven' and the Canadian system as being 'centrally controlled' is, increasingly, inept. Both systems are evolving toward bureaucratic models that rely more on internal competition than market competition for governance. In this respect, economic forces are nudging both systems towards a convergence of structure and performance.

Canada↗
PubMed2004

Putting E-government to work in healthcare environment: a multiregional project funded by the Italian Innovation & Technology Ministry.

In 2002, the Italian Ministry of Innovation promoted a national bid for e-government projects. Specifically it allocated a budget of 120 M euro. One of the four project approved in healthcare sector was the "Information, Care ("Assistenza" in Italian) and healthcare Education by the Web" (IAEW), with a global budget of 2580 k euro, partially financed by Ministry with a quota of 830 k euro. The project involves 12 medical structures (both national excellences centers and local regional hospitals) located in two different Region of North Italy, dealing with two different healthcare regional systems (Lombardia and Emilia-Romagna), with potentially 3 millions of users.

Computer Systems↗
PubMed1977

[Treatment of psoriasis with a derivative of retinoic acid by oral route].

In the study presented, an evaluation has been made of the results achieved in a group of 32 psoriatic patients treated with a derivative of the retinoid acid, i.e. Ro 10-9359, taken orally. The therapy used was considered highly favourable in 28 cases and favourable in 3. It is considered that the treatment is effective independently of the time of evolution and of the extension of seriousness of the disease with no effects on the visceral or humoral sectors. All the information included in the present study allows to assert that the treatment of psoriasis with this derivative of the retinoid acid represents a significant progress as compared with the corticoids or cythostatics therapy.

Administration, Oral↗
PubMed1996

Single-payer health insurance systems: national myths and immovable mountains.

Leaders in both government and the health-care industry have strong and varied opinions regarding the present US health-care system, but concur that health-care financing and organization need restructuring. The single-payer system offers the best framework for improving health-care universality, delivery, quality, access, choice, and cost effectiveness. However, the single-payer alternative often is dismissed early in debates on health-care reform. Popular aversion to collective governmental funding of health-care costs and the economic interests of the management, insurance, information, and profit sectors of the health-care industry are the critical impediments to adoption of single-payer insurance systems. This article examines the psychosocial and economic obstacles that prevent development of an efficient and effective health-care system and preclude recognition of the single-payer system as the best answer to health-care reform.

Developed Countries↗
PubMed1989

Maternal employment and infant mortality: an examination of the role of breastfeeding as an intermediate factor.

In a survey of 2111 mothers in Ile-Ife, Nigeria, the relationship between infant mortality and maternal employment was examined. By the use of logit regression taking socioeconomic variables and breastfeeding into account, it was shown that children of working class mothers are likely to experience higher rates of infant death than those of non-working mothers, and these rates are higher in mothers working in the informal than in the formal sector. No effect of duration of breastfeeding was detectable, probably due to the universal practice of long lactation among the Yoruba. Intensity of breastfeeding is a key variable, for when this is taken into account, the effect of maternal occupation on infant death disappears. Other variables associated with infant mortality are mother's education, father's income, mother's age, and age of infant.

Africa↗