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PubMed2005

Economic burden of obesity and its comorbidities in Switzerland.

OBJECTIVES: To estimate the total annual economic costs caused by overweight and obesity in Switzerland. METHODS: Top-down estimation of direct treatment costs for obesity including medication, nutritional counselling, and surgical interventions was carried out. Using Swiss prevalence data (2002) and literature-based estimates of the relative risks the population attributable fraction (PAF) was calculated for 18 overweight- and obesity-related diseases. PAF was then used in combination with estimates of the total (direct and indirect) health care costs of these diseases to estimate the economic burden of obesity for Switzerland. RESULTS: The estimated total costs in Switzerland amounted to CHF 2691 million per year (on cost basis 2001). Allowance for uncertainty in parameter assumptions and values in the published literature used applying a sensitivity range of +/- 20% gave a cost range of between CHF 2153 and 3 229 millions, representing approx. 2.3-3.5% of total health care expenditures. Overweight and obesity contribute each approx. 50% to these costs. CONCLUSION: Overweight and obesity represent a considerable financial burden to the Swiss society. According to their present trends, this economic burden is expected to grow over the coming years.

Body Mass Index↗
PubMed1991

The effect of a household partner and home urine monitoring on adherence to a sodium restricted diet.

To evaluate the effects of social support and home urine monitoring on success with dietary sodium reduction, 114 essential hypertensive adults and a household partner were recruited. One of the pair was required to be the food preparer. Patients with their partners were randomly assigned to either an active or passive partner condition. During dietary counseling in the active condition, both patient and partner were involved in instructions to change their diet to reduce their daily sodium intake to 80 mmol or less. In the passive condition, the partners were present during the dietary counseling, but no effort was made to involve them directly in the instruction or to encourage them to make personal dietary changes. Patients and active partners collected two 24-hr urine collections between each of the first two counseling sessions and received feedback on the sodium results by a telephone call. In the passive partner condition, only patients collected urine for feedback. At the end of the 6 week instructional period, all patients and partners collected a 24-hr urine and had their blood pressure assessed. Half of each group was also randomly assigned to have access to a system for periodic home-monitoring of urine for sodium content during a 3-month period beginning at week 6 of the study (immediate). The delayed feedback group received the home-monitoring three months after completion of the dietary instruction. All patients, but only active partners, used the feedback system during their assignment periods and collected a 24-hr urine monthly between 6 and 30 weeks of the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Diet, Sodium-Restricted↗
PubMed2002

Does patient educational level affect office visits to family physicians?

Significant disparities in health care based on patient socioeconomic status have been documented. The extent to which physician behavior accounts for these differences is not known. We examined the impact of patient socioeconomic status, measured by years of education, on physician behavior assessed by direct observation of office visits, chart audits, and patient reports among 138 family physicians in 84 practices. Outcomes included time use measured with the Davis Observation Code, delivery of preventive services recommended by the US Preventive Services Task Force, satisfaction assessed with the MOS 9-item Visit Rating Scale, and delivery of attributes of primary care measured by the Components of Primary Care Index. After controlling for patient characteristics among 2538 visits by adult patients who returned questionnaires, a high school education or less was associated with slightly greater proportion of time spent on physical examination and providing nutrition counseling, and less time on patient questions, assessing patient health knowledge, negotiation, and exercise counseling. This indicates that physicians adopt a more directive style with less educated patients. Screening tests were provided at lower rates among less educated patients, but there were no differences in rates of health habit counseling or immunization services delivered and no differences in delivery of patient-reported components of primary care. Less educated patients had similar overall visit satisfaction, but were slightly less likely to have their expectations met. These show that patients' education has relatively small, but potentially important, effects on the outpatient delivery of primary care.

Cross-Sectional Studies↗
PubMed2006

Pediatric perspective on prenatal counseling for myelomeningocele.

BACKGROUND: Over the past 35 years, advances in the prenatal diagnosis of spina bifida using ultrasound and laboratory testing have increased the number of patients seeking prenatal counseling. METHODS: Traditionally, this counseling has been provided by practitioners with little direct experience in the care of individuals with spina bifida across their life span. RESULTS: Physicians experienced in the care of children with spina bifida are able to provide information that is not available from other sources. CONCLUSIONS: This review provides a broad overview of many of the issues encountered during prenatal counseling sessions and emphasizes the additional value of the pediatric perspective during the process of informed decision making or preparation for an the birth of an affected child.

Counseling↗
PubMed2005

Improvements in advance care planning in the Veterans Affairs System: results of a multifaceted intervention.

BACKGROUND: Advance care planning (ACP) aims to guide health care in the event of decisional incapacity. Interventions to promote ACP have had limited effectiveness. We conducted an educational and motivational intervention in Department of Veterans Affairs outpatient clinics to increase ACP use and proxy and health care provider understanding of patients' preferences and values. METHODS: We recruited 23 providers and up to 14 of each of their patients; the patients were randomized to the control or intervention group. Eligibility criteria included a preexisting relationship with the provider, age 55 years or older, chronic health condition(s), and no recorded advance directive. The intervention group (n = 119) received an ACP workbook, motivational counseling by social workers, and cues to providers to discuss ACP. The control group (n = 129) received an advance directive booklet. RESULTS: The intervention patients reported more ACP discussions with their providers (64% vs 38%; P<.001). Living wills were filed in the medical record twice as often in the intervention group (48% vs 23%; P<.001). Provider-patient dyads in the intervention group had higher agreement scores than the control group for treatment preferences, values, and personal beliefs (58% vs 48%, 57% vs 46%, and 61% vs 47%, respectively; P<.01 for all comparisons). The agreement scores for the proxy-patient dyads did not differ between groups for treatment preferences and values, but were higher in the intervention than the control group for personal beliefs (67% vs 56%). CONCLUSION: This intervention demonstrates mixed results and highlights the ongoing challenges of helping health care providers and potential proxy decision makers represent patient preferences and values.

Advance Care Planning↗
PubMed1989

Knowledge and attitudes towards premarital counselling and examination.

Premarital counselling and examination have begun to play a very important role in the management of many genetic disorders. 600 villager's knowledge and attitudes toward premarital counselling and examination in Menofia Governorate was studied in order to predict the community acceptance and behaviour toward utilization of such service. The result showed a big lack in knowledge even among educated respondents about the term. The main source of information was mass media followed by medical personnel who should participate more in this service. Most respondents, except unmarried males, have a favourable attitude toward either premarital counselling and examination or consanguinous marriage. This may be related to certain social changes in village life such as declining illiteracy, increased economic pressures, increase number of nuclear families and accordingly delay in beginning a family. It was unlikely that non-contraceptive users would resort to induced abortion rather to use contraceptive methods. Educational programs should be directed toward: (a) unmarried males so that their attitude toward premarital counselling and examination can be changed to correct direction, (b) unmarried females to make consanginous marriage more undesirable, and (c) non-contraceptive users to make them more intended to use safe contraceptive methods than induced abortion.

Adolescent↗
PubMed1994

[Pathologic embryo examinations of induced and spontaneous abortions in the 1st trimester of pregnancy].

Morphological examination methods which are appropriate for detection of embryonic developmental defects are presented. The main emphasis is put on autopsy of small embryos using a dissection microscope and on documentation of the embryonic skeleton by means of skeleton staining. Through presentation of the embryopathological findings in 15 first-trimester abortion specimens we demonstrate that these examination techniques frequently allow diagnosis of isolated malformations as well as malformation syndromes, even in the fragmented or macerated embryo. Careful embryopathological examination and evaluation is a precondition for genetic counselling, as well as for goal-directed prenatal diagnostic measures in future pregnancies.

Abortion, Eugenic↗
PubMed2004

Abnormal fetal growth: intrauterine growth retardation, small for gestational age, large for gestational age.

The two extremes of abnormal fetal growth are restricted growth and excessive growth, both of which originate from alterations in the uterine metabolic milieu. The fetus must adapt to these conditions to survive. In both instances, however, the inciting insult and the subsequent adaptation of the fetus carry long-term health consequences. In some instances, these changes may have generational implications. Counseling and care by pediatricians should be directed at the continuum of age ranges, including the expectant mother, the newborn, the child and adolescent, and future generations.

Birth Weight↗
PubMed1976

Changing attendance patterns to sex therapy programs as a function of location and personnel.

This paper explores innovative treatment modalities that may encourage the participation of lower socioeconomic minority clients in sex therapy programs. It suggests the consideration of informal therapeutic settings, flexible hours, and an immediate contact with the therapist. It lends support to the concept that equal time be given to education and communication skills in counseling. It also stresses the necessity of directive yet permissive techniques to bridge the communication gap by identifying areas of commonality, especially when confronted with the lower socioeconomic minority client. The paper compares this approach with a sex therapy approach more oriented to the middle class.

Female↗
PubMedDate not supplied

Sociocultural and physiological correlates of cigarette smoking in women.

Cigarette smoking is a major modifiable risk factor for cancer and coronary heart disease and the chief avoidable cause of death in the United States. Over the past few decades, the prevalence of cigarette smoking among males has significantly decreased. However, the same significant decrease has not been seen among women. Researchers have identified sociocultural factors and physiological correlates associated with women's cigarette smoking. It is essential that health care professionals understand the findings of research on women's smoking if they wish to identify and counsel women at risk and to define directions for future research.

Adolescent↗
PubMed2000

Sudden cardiac death in heart failure.

Chronic heart failure (HF) and sudden cardiac death (SCD) present two major public health problems. The risk of death ranges from 10% to 50% annually in patients with HF, depending on the severity of disease. Approximately 50% of these deaths are sudden and presumed to be caused by dysrhythmias. This article defines the population at risk for SCD, explains the methods used for risk stratification, reviews current research on the pathophysiology of ventricular dysrhythmias in HF, and discusses pertinent clinical trials of therapeutic interventions on SCD in HF. The article also explores the effect of SCD on the patient and family with respect to counseling and education, resuscitative issues, and advanced directives.

Arrhythmias, Cardiac↗
PubMed1990

Prenatal sonographic evaluation of short-limbed dwarfism: an algorithmic approach.

Prenatal sonographic evaluation of short-limbed dwarfism is initiated when a significantly shortened femur is found or by referral of a patient with a family history of skeletal dysplasia. If a short femur is demonstrated, all the long bones are measured and evaluated for bowing, fractures, and mineralization. The bone dysplasia is categorized according to whether it is mesomelic, rhizomelic, or micromelic and whether bowing or fractures are present. The fetal spine, head, thorax, hands, and feet are carefully evaluated to differentiate the type of bone dysplasia and to determine whether it is lethal. Serial examinations may be necessary. This approach will provide sufficient information to counsel the family, manage the pregnancy, and direct the postnatal evaluation.

Algorithms↗
PubMed2005

Differences in quality of life before transplantation among transplant recipients with respect to selected socioeconomic variables.

PURPOSE: To examine differences in quality of life before transplantation among transplant recipients with respect to a selected set of socioeconomic variables related to household/housing, family social and health history, and availability and use of community resources. METHODS: An exploratory-descriptive study in a US university's transplant clinic. Sample included 249 kidney, liver, and pancreas transplant recipients aged 18 years or older. Instruments were a socioeconomic data questionnaire, the Sickness Impact Profile, the Adult Self-Image Scale, the Quality of Life Index, and a general quality of life scale. Descriptive statistics and analysis of variance with Bonferroni adjustment were used with a significance level of .05. Effect sizes were estimated. RESULTS: Quality of life did not differ significantly for any variable except for the use of private insurance combined with public health insurance. Such coverage was associated with significantly better scores on the psychosocial and total dimensions of the Sickness Impact Profile, indicating better health before transplantation. CONCLUSION: Researchers must first explore why a mix of private and public health insurance is associated with a higher quality of life and second reexamine whether these results occur at other transplant centers. These results also provide direction for social work professionals as they counsel patients in an attempt to help patients achieve a better psychosocial and physical quality of life before transplantation.

Analysis of Variance↗
PubMed1991

The Quick Response Team: a pilot project.

The Quick Response Team, consisting of physicians, nurses and social workers in an emergency room setting, conducted a five month pilot project whose overall goal was to eliminate unnecessary admissions to an acute care hospital. This paper reports on the three social work objectives of the program: high risk screening and direct intervention, including assessment, short-term counselling, information, and referral; follow-up services; and social work coverage to all units after hours. Over a 4 month period 11.6% of all patients in the emergency room were assessed by the social work staff and 24 non-acute admissions were deferred. The results of the study confirm the effectiveness of a social work presence in the emergency department in reducing non-acute admissions and in providing continuity of care for patients at high social risk.

Aftercare↗
PubMed1992

HIV disease: educational needs of Oregon family physicians.

Questionnaires were sent to 200 Oregon family physicians to assess their attitudes and educational needs concerning human immunodeficiency virus (HIV) related conditions. Completed questionnaires were returned by 160 (80%). Fifty-one percent had already managed patients with HIV disease or AIDS. Seventy-three percent indicated that HIV would have an effect on their future practice. Physicians were least comfortable in management areas concerning direct medical skills and most comfortable with counseling and behavioral science issues. Physicians were more likely to participate in "hotline consults," one-day regional workshops, and written protocols than in more high-tech, time-consuming methods of continuing medical education.

Attitude of Health Personnel↗
PubMed2005

[Global HIV care in general/family practice].

Dealing with HIV/AIDS in primary care encompasses preventive, curative, social and psychological aspects within a framework of a person-centred approach. Antiretroviral treatments enable the control of HIV infection, prevent opportunistic infections and allow patients to "live their life" with an increased life expectancy, active sexuality and need to procreate. The holistic care of patients should always be the primary concern. An increased involvement of GP's in HIV care can raise the quality of care, reduce the stigma and prejudice surrounding HIV Medical care providers can substantially affect HIV transmission by positively reinforcing changes to safe behavior, by referring patients for specialized services and working in direct collaboration with them, by facilitating partner counseling and testing. However, providers must interweave the "half-baked "science about drug therapies, side effects and drug interactions with the psychosocial and lifestyle factors of the patient. Sometimes it's not easy to find adequate and relevant information about HIV in primary care. This document will provide primary care givers the keys for improvement, increase their basic HIV-related skills (and strengthen their role in HIV/AIDS prevention and follow-up) and make them more confident in their assessments.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

An orientation model for correctional-health nursing.

A model to assist staff development educators with the orientation of nurses entering correctional health practice is introduced. The model incorporates the nursing process in screening activities, providing direct care, examining health behavior, teaching, and counseling incarcerated persons. The use of an education plan and contract for the adult learner, teaching strategies, method of evaluation and terminal behavioral objectives are discussed.

Humans↗
PubMedDate not supplied

[The medical service of sickness insurance: its future].

Since its creation, the Medical Service of Health Insurance has known an important evolution. Initially, its essential role was to control the allowances paid to the insured persons of the regimes of Health Insurance. Its aspect was rather coercive. But since 1960 a change has been outlined with the creation of the "Haut Comité Médical de la Sécurité Sociale": the Medical Control left its place to the Medical Service. With this denomination, its functions never stopped expanding. The Medical Service maintained its tasks of control devolved by the different regulations, and that is how it falls to it to express a view about long term diseases, disability occupational injuries, etc. It is also responsible for setting up "selective" controls with regard to some of medical or ancillary medical acts. But this taskwork is coupled with an important activity: the counsel. This responsibility is orientated in three directions: the Health Insurance Associations, the insured persons, and the Health Professions particularly as a part of the conventions binding them to the organizations of the French social protection system. During these last years new date intervened in health insurance matters in consequence of the economical crisis. Henceforward, it suits to find just a balance between a social protection of a high standard and adapted care of quality for the best cost. New opportunities are offered to the Medical Service to face this situation and gave it also a fresh impulse. This new evolution fits into an activity of public health considering the progress of the medicine. This activity must be orientated to a better knowledge of dispensed care and its good employment. Several orientations must be detained. In disease matters, informations in possession of the medical services are to be operated and, thanks to the data processing, a balance sheet of expenses will be drawn up, comparing them with diagnostic and therapeutic means. These studies, whose results will be published, must be guided with an exemplary scientific strictness and be supported by uncontested leading people in the medical world. Hospitalization is the other field where the role of the medical service must be essential. It certainly charges to continue the individual controls. But it must go further and be interested in the hospital working, as well as in the aggregate as by hospital service. This permits to get indispensable informations for useful decisions in view of a better hospitalisation.(ABSTRACT TRUNCATED AT 400 WORDS)

Costs and Cost Analysis↗