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PubMed2003

Sleep apnoea: Finnish National guidelines for prevention and treatment 2002-2012.

(1) After negotiations with the Finnish Ministry of Social Affairs and Health, a national programme to promote prevention, treatment and rehabilitation of sleep apnoea for the years 2002-2012 has been prepared by the Finnish Lung Health Association on the basis of extensive collaboration. The programme needs to be revised as necessary, because of the rapid development in medical knowledge, and in appliance therapy in particular. (2) Sleep apnoea deteriorates slowly. Its typical features are snoring, interruptions of breathing during sleep and daytime tiredness. Sleep apnoea affects roughly 3% of middle-aged men and 2% of women. In Finland, there are approx. 150,000 sleep apnea patients, of which 15,000 patients have a severe disease, 50,000 patients are moderate and 85,000 have a mild form of the disease. Children are also affected by sleep apnea. A typical sleep apnea patient is a middle-aged man or a postmenopausal woman. (3) The obstruction of upper airways is essential in the occurrence of sleep apnoea. The obstruction can be caused by structural and/or functional factors. As for structural factors, there are various methods of intervention, such as to secure children's nasal respiration, to remove redundant soft tissue, as well as to correct malocclusions. It is possible to have an effect on the functional factors by treating well diseases predisposing to sleep apnoea, by reducing smoking, the consumption of alcohol and the use of medicines impairing the central nervous system. The most important single risk factor for sleep apnoea is obesity. (4) Untreated sleep apnoea leads to an increase morbidity and mortality through heart circulatory diseases and through accidents by tiredness. Untreated or undertreated sleep apnoea deteriorates a person's quality of life and working capacity. (5) The goals of the Programme for the prevention and treatment of sleep apnoea are as follows: (1) to decrease the incidence of sleep apnoea, (2) to ensure that as many patients as possible with sleep apnoea recover, (3) to maintain capacity for work and functional capacity of patients with sleep apnoea, (4) to reduce the percentage of patients with severe sleep apnoea, (5) to decrease the number of sleep apnoea patients requiring hospitalisation and (6) to improve cost effectiveness of prevention and treatment of sleep apnoea. (6) The following means are suggested for achieving the goals: (1) to promote prevention of obesity, weight loss and weight control; (2) to promote securing of nasal respiration in child patients and removal of obstructing redundant soft tissues; (3) to promote the correction of children's malocclusions, (4) to enhance knowledge about risk factors and treatment of sleep apnoea in key groups, (5) to promote early diagnosis and active treatment, (6) to commence rehabilitation early and individually as a part of treatment and (7) to encourage scientific research. (7) On the national level, the occurrence of sleep apnoea can be prevented, for example, by encouraging weight control. The programme gives examples of such measures and appeals to various authorities and voluntary organisations to reinforce their collaboration. Preventive measures should be individualised, and based on due consideration. (8) The efficacy of diagnosing sleep apnoea should be increased. Attention should be paid to the symptoms of risk group patients at different units of the primary and occupational health care. Even mild forms of the disease should be treated appropriately. Diagnosis and treatment of the disease involve cooperation between the primary and specialised health-care sectors. Methods of treatment are (1) treatment of obesity, (2) positional therapy, (3) reduction of the use of medicines impairing the central nervous system, (4) reduction of smoking and the consumption of alcohol, (5) devices affecting the position of the tongue and lower jaw, (6) treatment with Continuous Positive Airway Pressure (CPAP-treatment), (7) surgical methods of treatment and (8) rehabilitation. (9) The hierarchy of referrals in the prevention and treatment of sleep apnoea 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 specialised medical-care sectors should be developed. Hospitals districts in cooperation with provincial governments and municipalities should ensure that different levels of the health-care system are capable of fulfilling the tasks assigned to them appropriately. (10) Rehabilitation of sleep apnoea should be goal-orientated and cover all forms of rehabilitation: medical, occupational and social. Rehabilitation should prevent the effects caused by the disease. Thus, it is possible to support self-care, increase the patient's resources and improve quality of life. (11) Information and training should be directed primarily towards health-care personnel, patients and their families. Organisations should produce materials for health and patient education as well as organising training events. To support the activities. financing will be needed from organisations such as Finland's Slot Machine Association. The Social Insurance Institution should disseminate information about questions of social security. Regional direction and training will mainly be the responsibilities of hospital districts, provincial governments and local health centres. The media will play an important role in the dissemination in-depth information about prevention and treatment of sleep apnoea.

Child↗
PubMed2001

[The population treated in the general psychiatric sector in 1993 and 1998. Clinical and demographic evolution].

BACKGROUND: The French information system in public psychiatry sectors does not collect morbidity data for the population being treated, estimated as more than a million persons in 1997. Consequently, two surveys were financed by the "Direction Générale de la Santé" and carried out in 1993 and 1998 in order to specify clinical, social and demographic characteristics of the patients. These surveys allowed a follow-up of evolutions according to the pathology and mode of treatment in a context where outpatient treatments are becoming increasingly frequent. METHODS: A census of the patients was made at a given moment, between one and fifteen days according to the mode of treatment. One sector out of two was surveyed, using a systematic selection process. The ICD-10 was used for diagnosis reference. The same methodology was applied in 1993 and 1998. Comparisons were made with the data supplied by the sectors annually and with the data concerning the general population in order to calculate rates per age groups. RESULTS: Between 1993 and 1998, the number of patients increased by +37% in outpatient care, and in part time care, and decreased by -12% in full time care. Rates for patients increased for all age groups in outpatient and part time care, more particularly for the 35 to 49 years old. Conversely, rates decreased in full time care, above all for patients over seventy. In each mode of treatment, the number of patients presenting mood disorders and neurotic disorders increased more than the average, and the proportion of patients with organic mental disorders and mental retardation decreased. Evolutions were different according to the mode of treatment schizophrenia, schizotypal and delusional disorders, and disorders of adult personality and behaviour. CONCLUSIONS: Recourse to outpatient care and part time care increased considerably over five years but evolutions were markedly different from one diagnosis to another. In full time care, the decrease more particularly concerned certain pathologies and age groups. Three phenomena, with possible interactions, could explain the evolutions observed: the population liable to have recourse to psychiatric care is increasing, health policies have changed and care supply has become diversified, and recourse to psychiatric care is now increasingly accepted.

Adult↗
PubMed2001

[Personal identifiability in the Health Sector Database.].

INTRODUCTION: Personal identifiability is a fundamental question in the debate about the Bill and Act on the Health Sector Database (HSD). If the data are personally identifiable, Iceland's international committments dictate that a priori consent be obtained from patients for the use of their health records data. The HSD Act presumes that one way encryption renders the data non-personally identifiable and that therefore an a priori consent is not required. RESULTS: The history of the concept of personal identifiability during the debate on the HSD reveals changes made to the concept. In the first instance a reference was made to Recommendation R(97)5 of the Council of Europe Committee of Ministers which was changed by adopting a direct translation of the definition of personal data from the Directive 95/46/EC of the European Parliament and of the Council. These changes were made in response to the Data Protection Commission's opinion on the HSD Bill submitted to the Minister of Health that overturned the ideology previously used regarding indentifiability of persons. Information is identifiable if there exists a key and it makes no difference who holds the key. One way encryption was then adopted as a method that was supposed to mean that a key does not exist. Nevertheless, the database proponents now admit that a key exists. The making of keys for opening up the database is discussed. The database is a longitudinal collection and linkage of records on each individual and therefore the method of encryption must remain stable. Therefore, anyone with access to the method can easily make a lookup-table containing side by side the names and the personal numbers produced by the encryption. Although it may be hard to go from a personal number directly back to a name, given the table it always is possible to look up what personal number belongs to a certain person or what person stands behind a certain personal number. This is a key. If the method of encryption was lost or access to it was not available it would nevertheless be possible to make a key. The intention is to encrypt the genealogy of the entire nation using the same encryption method used for the HSD. The genealogy of the nation with names is also generally available. The patterns of family trees become unique when one family is connected to another through marriage and childbirth. A comparison of the encrypted genealogy containing personal numbers with the same genealogy containing names is therefore a method for making a key. Finally a key can be made from the context of general information. Even if the names were irreversibly removed there will be enough available bits of general information connected to a personal number to allow re-identification of the person in a large number of instances. This amounts to making a key. CONCLUSIONS: The information in the Health Sector Database is personal information. Therefore it is both right and reasonable to obtain an a priori consent of patients for the transfer of their health data to the database as Iceland's international obligations stipulate. Anything less is unreasonable.

English Abstract↗
PubMed2000

Informed consent for stem cell research in the public sector.

Asking progenitors of spare embryos to donate them for use in stem cell research presents a number of complex issues, especially given the general lack of regulation of fertility medicine and the lack of public consensus on the moral status of the embryo. Particular issues include the timing of the request for donation and whether both men and women must always give consent for the use of their embryos for research. If thoughtful attention is given to these matters, there need be no ethical impediment to requesting the use of spare embryos for stem cell research.

Adult↗
PubMed2006

[Health and the media in Spain].

The so-called media agenda has a great influence on the issues considered to be important by society. In this article, based on the Informe Quiral (Quiral Survey), the author analyses the coverage of health issues in Spanish press. In Spain, media concentration causes a clear tendency to information homogeneity and thus, health issues are rarely dealt with in an independent way or in its own specific space or by specialized professionals. The main chronic issues the Spanish press has followed during the years included in the survey have been: cancer, sexuality and reproduction, aids, drugs (including tobacco), mental disorders and nutrition-related issues. Politicians or individuals with political and technical posts are the sources which carry the burden of informing about health issues (49%). On the other hand, the more specialized sector is the source of information in only 26% of the cases. In order to improve health information, the author suggests establishing communication platforms and closer collaboration between the specialized sector and the media, fostering mutual knowledge of all professional groups taking part in the process and ridding health information of all political influences.

Communications Media↗
PubMed2003

Digital imaging overview.

Digital imaging consists of digital acquisition modalities, image, and information management systems. All modalities are available to be purchased as digital acquisition devices. Image management has been the domain for PACSs. PACSs are complex systems designed to transmit, store, and display medical images. They use and rely on many types of different information and display technologies. The initial focus for PACSs has been on solving the engineering issues associated with the transfer of large image data sets and the suitability of softcopy displays for diagnosis particular to the human visual system. For operating within a centralized radiology department, these are largely solved. However, for enterprise wide dissemination and distribution, there are still challenges in the form of expedient transfer syntaxes and image quality, but these are also being effectively addressed. Information management is the domain of the RIS. One of the goals of radiology management should encompass the development of a robust practice environment that emphasizes workflow enhancements with seamless integration of decision support tools. The concept of "person-machine" systems emphasizes taking full advantage of both human and machine capabilities with a capacity to grow and change function. As the computer capabilities increase, more jobs can be relinquished to the machine. The physician can then focus on tasks that require more complex judgment and comprehension. The goal of this human-machine hybrid is to have more power than either of its components alone. This multifaceted role will most likely be embedded in the background having agents query and retrieve context specific information to be presented to the user. As augmenters of human talent, computers can turn data into information and information into knowledge. Medical imaging is a beneficiary of the information technology developments driven by the consumer and business sectors. Although these applications of information technologies are not a solution to every problem, it certainly can bring the radiology department much closer to the desired ideal operational model. Even though there are many challenges to overcome, the benefits derived from a successful RIS/PACS implementation can be instrumental toward achieving a level of excellence in clinical service, teaching, and research that is unrivaled. Strategies for change management and quality improvement should begin by considering the entire chain of events from image acquisition through display to communication of a report.

Computer Communication Networks↗
PubMed2004

The feasibility of government partnerships with NGOs in the reproductive health field in Mexico.

In 1995 the Mexican government began to develop policies on establishing collaborative agreements with civil society organisations, and there is currently interest in Mexico in government and NGOs working together. This paper analyses whether the conditions exist in Mexico for successful partnerships between the public sector and NGOs in the reproductive health field. In-depth interviews were carried out with key informants in the public sector at national and state level and the NGO sector in six states in Mexico. Partnerships were found to be an option for the provision of reproductive health services in geographical areas where the population is under-served, and for services the government does not provide. While the contribution of NGOs to the reproductive health field is recognised, at least at federal level, there are still very few public agencies that collaborate with NGOs, and agreements are often limited to short-term financing of projects. The future of NGOs in Mexico will depend largely on their ability to obtain funding from within the country. More effective mechanisms are needed by government to generate resources for health care. Government must recognise the specific contribution of NGOs, including inputs of social capital and creation of community networks, and must share decision-making more equitably with NGO for partnerships to succeed.

Cooperative Behavior↗
PubMed1995

Access to elective surgery at electoral ward level: the impact of the private sector.

BACKGROUND: Purchasers of health care receive no routine information on the use of the private health sector by their residents, and are consequently unaware of any resulting differentials in access to health services. This information would assist in assessing need for services on a locality basis. METHODS: For the period 1990-1992 surgical activity data from the single private hospital in Preston were examined by electoral ward of residence and compared with corresponding NHS data. RESULTS: For the procedures examined, the private sector contributed only 8 per cent to overall surgical activity within Preston. People from the more affluent wards were far more likely to use the private sector than those from deprived wards. CONCLUSION: The private sector did not introduce any inequity of access to surgery within Preston at electoral ward level. However, in districts with higher levels of private sector activity significant differentials in access may exist.

Elective Surgical Procedures↗
PubMed1999

Independent sector regulation. Privates on parade.

The government's proposal to set up a new regulatory body for the private and voluntary sectors is regrettable. The major hospital groups in the private sector could undertake some system of clinical governance. Whatever form regulation takes, it must be supported by much better information on the private sector, including consultants' activity rates and rates of re-admission and numbers of transfers to NHS hospitals.

Facility Regulation and Control↗
PubMed2006

Job satisfaction and stress among pharmacists in the long-term care sector.

OBJECTIVE: To provide normative information regarding levels of job satisfaction and stress between consulting and dispensing pharmacists in the long-term care arena. DESIGN: Cross-sectional. SETTING: United States. PARTICIPANTS: All current members of the American Society of Consultant Pharmacists as of March 2005. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Health Professional Stress Inventory. RESULTS: More than 90% of consultant pharmacists were satisfied with their jobs. The most frequently reported source of stress among the pharmacists was short staffing, affecting their ability to perform their duties. More than one-third of dispensing pharmacists were often stressed, frequently because of the need to keep up with developments to maintain professional competence. CONCLUSION: Pharmacists serving the long-term care sector are very satisfied. Methods to assist dispensing pharmacists to keep up with practice developments must be explored. Whether or not new models of long-term care pharmacy improve job satisfaction must be explored.

Consultants↗
PubMed2003

The Danish National Health Informatics Strategy.

The central vision for the future information systems in the Danish health care sector is one of a generally accepted, common information model enabling comprehensive digital reuse of shared clinical data. A generic 'Basic-EHR-structure' has been developed for this purpose by the National Board of Health from a through analysis of the production of clinical information. The strategy contributes to the achievement of the national political goals for the health care sector and describes four important steps to be made by the health care IT systems in order to reach full interoperability and digital reusability of clinical information. Some important initiatives of the strategy are a national terminology server, coordinated implementation of EHRs, and the Public Health Information Portal.

Denmark↗