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PubMed2000

Pilot study for appropriate anti-infective community therapy. Effect of a guideline-based strategy to optimize use of antibiotics.

OBJECTIVE: To determine whether a community-wide, multi-intervention educational strategy (CoMPLI model) could enhance adoption of clinical guidelines and improve the use of antibiotics. DESIGN: Before-after trial using baseline and study periods with a control group. SETTING: A small community in central Ontario. PARTICIPANTS: Health professionals, the general public, and the pharmaceutical industry. INTERVENTIONS: The educational strategy (CoMPLI), carried out during 6 winter months, consisted of continuing medical education sessions for health professionals and pharmaceutical representatives and a parallel public education campaign that included town hall meetings and pamphlets distributed by local pharmacists. The two main messages were: do not use antibiotics for viral respiratory infections, and use drugs recommended in the publication, Anti-infective Guidelines for Community-Acquired Infections. MAIN OUTCOME MEASURES: Total number of antibiotic claims and adjusted odds ratios (OR) were used to measure the likelihood of physicians prescribing first- or second-line agents compared with the previous year and compared with control physicians. RESULTS: Claims in the study community decreased by nearly 10% during the 6-month study period compared with the baseline period from the previous year. Study physicians were 29% less likely (OR-1 = 0.71, range 0.67 to 0.76) to prescribe second-line antibiotics during the study period than physicians in the rest of the province. CONCLUSIONS: Physicians participating in the pilot study were more likely to follow drug recommendations outlined in published guidelines.

Adult↗
PubMedDate not supplied

Evaluating injury prevention programs: the Oklahoma City Smoke Alarm Project.

Evaluation of injury prevention programs is critical for measuring program effects on reducing injury-related morbidity and mortality or on increasing the adoption of safety practices. During the planning and implementation of injury prevention programs, evaluation data also can be used to test program strategies and to measure the program's penetration among the target population. The availability of this early data enables program managers to refine a program, increasing the likelihood of successful outcomes. The Oklahoma City Smoke Alarm Project illustrates how an evaluation was designed to inform program decisions by providing methodologically sound data on program processes and outcomes. This community intervention trial was instituted to reduce residential fire-related injuries and deaths in a geographic area of Oklahoma City that was disproportionately affected by this problem. The distribution of free smoke alarms in targeted neighborhoods was accompanied by written educational pamphlets and home-based follow-up to test whether the alarms were functioning correctly. Early evaluation during the planning and implementation phases of the program allowed for midcourse corrections that increased the program's impact on desired outcomes. During the six years following the project, the residential fire-related injury rate decreased 81% in the target population but only 7% in the rest of Oklahoma City. This dramatic decline in fire-related injuries in the target area is largely attributed to the free smoke alarm distribution as well as to educational efforts promoting awareness about residential fires and their prevention.

Adolescent↗
PubMedDate not supplied

[Changes in HIV-related attitudes and knowledge of teenagers following the Aulasida intervention in 1996-1997].

BACKGROUND: Schools being the ideal setting for carrying out Health Education activities, the aim of this study was that of pinpointing and quantifying the changes in attitudes and knowledge on the part of teenagers enrolled in school in Algemesí (Valencia) following an educational intervention regarding HIV infection. METHOD: Eleven schools at which a total of 2,599 teenagers (ages 12-19) were enrolled in eleven different years of study (Secondary Education, Secondary Ed. and School Leaving Certificate, College Preparation Course and Vocational Training) were invited to take part. The Aulasida intervention carried out during the 1996-1997 school year consisted of an informative lecture-panel discussion and student involvement activities in small groups using educational materials. The gauging instrument was a questionnaire. This questionnaire was designed in a before-and-after cross-sectional study. An analysis was made divided into age and educational level strata. The averages were compared with the Student "t" test and the percentages of change with ji square. RESULTS: A total of nine schools accepted taking part. 1575 students answered the "before" test (47.4% males and 52.1% females), the average age being 15.2 (1.96) years old. The average number of correct answers to the "before" test was 13.5 (2.8). The "after" test showed an overall increase of up to 14.7 (3.0) correct answers (p < 0.01). By educational levels, this increase was highly appreciable in the younger age group. The most common sources of information on HIV were: television (80.8%); Aulasida (76.8%), teachers (60.9%), pamphlets (58.4%) and films (53.7%9. CONCLUSIONS: Educational interventions are useful tools for increasing knowledge and improving attitudes regarding HIV infection. Secondary schools are the best environment for this purpose, it being necessary to carry out interventions among younger groups, as a greater impact is thus achieved.

Adolescent↗
PubMed2000

Continuation rates for oral contraceptives and hormone replacement therapy. The ESHRE Capri Workshop Group.

Despite the safety and effectiveness of low oestrogen-dose oral contraceptives (OC) and postmenopausal hormone replacement there is poor continuity of use of these agents by women. Patterns of use and the reasons affecting different frequencies of use in different countries are presented. Continuity and discontinuation rates are difficult to assess accurately but it is believed that the main reasons why women discontinue use of these agents are concerns about their perceived health risks and the presence of, or fear of, adverse clinical effects, particularly unscheduled uterine bleeding and weight gain. More information is needed about OC continuation rates in order to improve the acceptability of these safe, effective agents. Most women discontinue use of postmenopausal hormonal replacement within 2 years of initiating the therapy. Reasons include disappearance of symptoms of oestrogen deficiency, lack of awareness of health benefits of oestrogen, presence of side-effects (such as breast tenderness and weight gain), presence of uterine bleeding and increasing age. Suggestions to increase continuation of OC include extensive individual pretreatment counselling with a different emphasis in different age groups, education at the time of follow-up visits and telephone calls, and extensive use of educational aids such as brochures, pamphlets and audio tapes, and improvement of pharmaceutical packaging information. In conclusion there is an urgent need to assess the value of these strategies by long-term large controlled studies.

Adult↗
PubMed2000

[Continuous nursing of incurable patients at home--the case of a patient with Parkinson's disease].

At the Department of Neurology and Internal Medicine at our hospital, there are 22 outpatients who are nursed at home. Their diseases are Parkinson's disease, spinal cerebellar degeneration, dementia and other diseases. The problem is how we should care for and support these patients in the future, now that the official Care Insurance System has started. We discuss how we could support such patients, through the case of a patient suffering from Parkinson's disease. The patient was a 69-year-old female. In 1991, she developed Parkinson's disease, accompanied with trembling in her right upper limb. Her condition was controlled at our hospital. Is April 1999, she lost strength in her right thigh without any previous notice, so she was hospitalized for treatment. For a period, she became aggressive from hallucinations and delusions and she had to be taken care of all day. Her only daughter lived apart and her 72-year-old husband was also suffering from Parkinson's disease. In spite of such conditions, she hoped to receive home care and her husband accepted that. We asked what they would want us to do. We had meetings together with the staff of the local administration, doctors, nurses, and pharmacists. The report from our hospital staff says, "It may be difficult for only her family to support her. She needs other supporting systems." She came to our hospital twice a month. We made an effort to understand her condition with the help of the report of a visiting nurse. However, her illusions and delusions made it difficult even to utilize the short-stay. Her husband sometimes uses violence and says. "I can't stand this any more--her unrest, micturition at night and refusal to eat." Nevertheless, she continues to say "I want to stay at home." They have had considerable trouble. The following are necessary for home care of some patients. 1. Understanding what a patient and her family want to do. Cooperating with the staff of the administration, in consideration of the Care Insurance System. 2. Studying with incurable neurology patients using pamphlets or other materials and supporting them, 3. Discussing how to act in concert with patients at home and outpatients at the hospital involving a risk without MSW.

Aged↗
PubMed2000

National Cancer Policy Board Report.

While collecting information for a consumer pamphlet to assist cancer patients in navigating through the medical system, the National Cancer Policy Board discovered the data that were available were critically insufficient. In response, the turned their attention to analyzing our ability to assess quality of cancer care. Their findings along with ten recommendations were published in April 1999. In particular, their conclusions concerning data collection and volume outcomes surprised many in the oncology community. These comments along with five of their recommendations--high-volume settings, standard guidelines, the elements of quality care, measuring and monitoring quality care, and end-of-life care--are presented in this panel discussion.

Health Policy↗
PubMed2001

Playing by the rules. How Intel avoids antitrust litigation.

Microsoft and Intel are both obvious targets for antitrust litigation; both wield considerable control in their respective segments of the computer industry. But while Mircrosoft has been mired in court for years now--its name and business practices dragged through the mud, and its very future as a single company thrown into doubt--Intel has avoided a prolonged, high-profile antitrust case. Intel's success is not a matter of luck. The company's antitrust compliance program, refined over many years, has been an integral element in the chip maker's business strategy. In this article, the authors suggest that Intel's approach to compliance provides a valuable model for any enterprise that may come under regulators' scrutiny. They describe how Intel created extremely conservative antitrust compliance standards and then instituted a series of unique training events that had active support from then--CEO Andy Grove and others in senior management. First, live training -- not just instructional pamphlets or videos -- was given to all affected employees. Those classes were followed by customized training programs for different parts of the company. Then, to drive antitrust awareness deeper into the company's memory, Intel carried out random audits of employees' files and conducted mock depositions. "It's fascinating to see," Grove says. "A memo is introduced into evidence and you shrug. You fully understand how that memo could be written. Moreover, you could have written it yourself. And then you see that memo turned into a tool and a weapon against you, in front of your eyes." Intel recognizes that no matter how cautious it is, it will always face extraordinary scrutiny as a market leader. But "since antitrust is embedded in everything we do," Grove says, "we can control our destiny."

Antitrust Laws↗
PubMed2001

The enhanced anticaries efficacy of a sodium fluoride and dicalcium phosphate dihydrate dentifrice in a dual-chambered tube. A 2-year caries clinical study on children in the United States of America.

PURPOSE: To clinically evaluate and compare a dentifrice system in a dual-chambered tube, wherein one chamber contained sodium fluoride in a silica base and the other chamber contained dicalcium phosphate dihydrate (Test Dentifrice delivering 0.243% sodium fluoride), to a dentifrice containing 0.243% sodium fluoride in a silica base (Positive Control Dentifrice). MATERIALS AND METHODS: This study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward the comparison of fluoride dentifrices. This 2-yr caries clinical study employed a double-blind, parallel-group design, and involved 5-17 yr-old children from the Central and South areas of Florida and from the Lares area of Puerto Rico. Qualifying subjects were stratified according to age and sex, and were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. Two calibrated examiners performed all the measurements. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by indoctrination in proper oral hygiene techniques by dental professionals, supplemented by pamphlets supplied by the sponsor and yearly mailings to participants, emphasizing good oral hygiene and the need to enforce compliance with the study. Post-baseline examinations were performed after 1 yr of product use, and again after 2 yrs of product use. RESULTS: Two thousand five hundred six (2,506) subjects completed this 2-yr study. For these subjects, the mean caries scores (DMFS, decayed, missing and filled tooth surfaces) at baseline were 2.29 for the Test Dentifrice group, and 2.47 for the Positive Control Dentifrice group. For caries increments after 1 yr, the respective means were 0.69 for the Test Dentifrice group and 0.81 for the Positive Control Dentifrice group. Finally, after 2 yrs, the mean caries increments were 1.25 for the Test Dentifrice group, and 1.46 for the Positive Control Dentifrice group. No statistically significant difference was indicated between the treatment groups at baseline or between the 1-yr caries increment scores. However, there was a statistically significant difference in the 2-yr caries increment scores between the treatment groups. Relative to the Positive Control Dentifrice group, the Test Dentifrice group presented a 14.38% reduction in caries increment scores at 2 yrs. In accordance with the procedures and standards provided by the published guidelines of the American Dental Association for the comparison of the anticaries efficacy of fluoride dentifrices, the results of this study support the conclusion that the dentifrice system in a dual-chambered tube, wherein one chamber contained sodium fluoride in a silica base and the other chamber contained dicalcium phosphate dihydrate, delivering 0.243% sodium fluoride, provided a superior level of anticaries efficacy than did the dentifrice containing 0.243% sodium fluoride in a silica base.

Adolescent↗
PubMed2001

The enhanced anticaries efficacy of a sodium fluoride and dicalcium phosphate dihydrate dentifrice in a dual-chambered tube. A 2-year caries clinical study on children in Brazil.

PURPOSE: To clinically evaluate and compare a dentifrice system in a dual-chambered tube, wherein one chamber contained sodium fluoride in a silica base and the other chamber contained dicalcium phosphate dihydrate (Test Dentifrice delivering 0.243% sodium fluoride), to a dentifrice containing 0.243% sodium fluoride in a silica base (Positive Control Dentifrice). MATERIALS AND METHODS: This study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward the comparison of fluoride dentifrices. This 2-yr caries clinical study employed a double-blind, parallel-group design, and involved 6-10 yr-old children from the metropolitan area of Maceio, Alagoas, Brazil. Qualifying subjects were stratified according to age and sex, and were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. One calibrated examiner performed all the measurements. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by indoctrination in proper oral hygiene techniques by dental professionals, supplemented by pamphlets supplied by the sponsor and yearly mailings to participants, emphasizing good oral hygiene and the need to enforce compliance with the study. Post-baseline examinations were performed after 1 yr of product use, and again after 2 yrs of product use. RESULTS: Two thousand four hundred thirty-two (2,432) subjects completed this 2-yr study. For these subjects, the mean caries scores (DMFS, decayed, missing and filled tooth surfaces) at baseline were 3.84 for the Test Dentifrice group, and 4.06 for the Positive Control Dentifrice group. For caries increments after 1 yr, the respective means were 2.02 for the Test Dentifrice group and 2.12 for the Positive Control Dentifrice group. Finally, after 2 yrs, the mean caries increments were 4.30 for the Test Dentifrice group, and 4.83 for the Positive Control Dentifrice group. No statistically significant difference was indicated between the treatment groups at baseline or between the 1-yr caries increment scores. However, there was a statistically significant difference in the 2-yr caries increment scores between the treatment groups. Relative to the Positive Control Dentifrice group, the Test Dentifrice group presented a 10.97% reduction in caries increment scores at 2 yrs. In accordance with the procedures and standards provided by the published guidelines of the American Dental Association for the comparison of the anticaries efficacy of fluoride dentifrices, the results of this study support the conclusion that the dentifrice system in a dual-chambered tube, wherein one chamber contained sodium fluoride in a silica base and the other chamber contained dicalcium phosphate dihydrate, delivering 0.243% sodium fluoride, provided a superior level of anticaries efficacy than did the dentifrice containing 0.243% sodium fluoride in a silica base.

Brazil↗
PubMed2001

[The total-quality-management-analysis of the continuation and discontinuation of alcohol family treatment: a grassroots approach].

A family support/treatment program was provided to thirty-three cases where a drinking family member (identified patient) had shown alcohol related problems but not yet admitted the problem. After a period of between thirteen and twenty-one months of family treatment, fourteen (42.4%) identified patients started their own treatment. The only statistically significant factor that was related to the patients' treatment program participation was the continuation of family members' involvement in a family treatment program. Among the thirty-three cases, a little less than one half (48.5%) continued the family program. In order to increase the patients' participation, it is crucial to encourage family members to continue their family support/treatment program. In order to identify factors that contribute treatment continuation as well as dropouts, workshops were held with those who dropped out and those who continued the family treatment program. The Total-Quality-Management (TQM) affinity and arrow diagram techniques were employed to classify the participants' statements and to find cause-effect relationships among the identified factors, respectively. Five family treatment discontinuation factors were identified: 1) a lack of information about family support program, 2) resistance against a "family change" orientation in family treatment program, 3) family member burnout, 4) a misfit between family needs for immediate problem solutions and what family program offers, and 5) a temporal improvement of patients' drinking problems. While widely varied factors were found to contribute discontinuation, only a very few factors were identified to facilitate the treatment continuation. It was concluded that treatment discontinuation, rather than continuation, was the norm among the families of problem drinkers. Based on the above findings, three kaizen plans were proposed. First, in order to make sure that family members obtain necessary information about the family support/treatment program, a pamphlet would be created and handed out to those who come to family treatment. Second, family support efforts would be emphasized more. Treatment staff is expected to become more cautious with regard to the family behavior change facilitation, especially at the early stage. Third, treatment staff is expected to become more aggressive about contacting family group members when they do not show up to a meeting.

Adult↗
PubMed2001

The comparative anticaries efficacy of a dentifrice containing 0.3% triclosan and 2.0% copolymer in a 0.243% sodium fluoride/silica base and a dentifrice containing 0.243% sodium fluoride/silica base: a two-year coronal caries clinical trial on adults in Israel.

The purpose of this two-year clinical study was to provide a comparison of the anticaries efficacy associated with two commercially available, American Dental Association-accepted dentifrices: Colgate Total Toothpaste, which contains 0.3% triclosan and 2% copolymer in a 0.243% sodium fluoride/silica base; and Crest Cavity Fighting Toothpaste with Fluoristat, which contains 0.243% sodium fluoride in a silica base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward the comparison of fluoride dentifrices. The study employed a double-blind parallel-group design, and involved adults living in communities throughout Israel. Qualifying subjects were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. Two calibrated examiners performed all of the measurements. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by indoctrination in proper oral hygiene techniques by dental professionals, supplemented by pamphlets supplied by the sponsor and yearly mailings to participants, emphasizing good oral hygiene and the need to ensure compliance with the study. Post-baseline examinations were performed after one year of product use, and again after two years of product use. Three-thousand, three-hundred and ninety-two (3,392) subjects completed this two-year study. For these subjects, the mean caries scores (DFS, decayed or filled surfaces) at baseline were 21.96 for the Colgate Total Toothpaste group, and 21.49 for the Crest Cavity Fighting Toothpaste with Fluoristat group. For caries increment after one year, the respective means were 1.37 for the Colgate Total Toothpaste group, and 1.56 for the Crest Cavity Fighting Toothpaste with Fluoristat group. After two years, the mean caries increments were 1.46 for the Colgate Total Toothpaste group, and 1.75 for the Crest Cavity Fighting Toothpaste with Fluoristat group. No statically significant difference was indicated between the treatment groups at baseline. However, for both the one-year and two-year increments, there was a statistically significant difference between treatment groups. Relative to the Crest Cavity Fighting Toothpaste with Fluoristat group, the Colgate Total Toothpaste group presented a 12.2% reduction in caries increment scores at one year, and a 16.6% reduction in caries increment scores at two years. In accordance with the procedures and standards provided by the published guidelines of the American Dental Association for the comparison of the anticaries efficacy of fluoride dentifrices, the results of this study support the conclusion that Colgate Total Toothpaste provides a superior level of coronal anticaries efficacy compared to Crest Cavity Fighting Toothpaste with Fluoristat.

Adult↗
PubMed1998

[European physician - travellers and the Ottoman Empire].

The Ottoman Empire has always been a centre of attraction for the West all through its history. On the occasion of various reasons, Western travellers visited the Empire and published a great deal of journals, pamphlets, books and memoirs of their journeys in the country based on their impressions, observations, experiences and missions etc. Most of these books of travel were printed, though some of them sank into oblivion in manuscripts in the European archives and libraries. Unfortunately we do not have a specific library in Istanbul where these printed travel books are collected, except for those in private collections. In this paper, the three books of travel chosen from my personal library and written by an English, a French and a German-Swiss military physician are going to be reviewed successively. The book firstly studied, Memories of the Crimean War from January 1855 to June 1866, was written by Dr. D. A. Reid and printed in London in 1911. It narrates the impressions, and services of the physician in the Crimean war and gives information on the sick, the wounded, infirmaries and the diseases in the battle field and also on the military hospitals and medical care in Istanbul. The second book titled Impressions de Voyage de Paris a Sebastopol, was written by Dr. Felix Maynard, and published by Alexandra Dumes in Paris in 1855. It relates the impressions of the author during his visits to the various parts of the cities and people in Greece and Istanbul. The third book Erinnerungen eines Schweizerarztes aus dem griechisch-turkischen Krieg was written by Dr. Armin Muller who served in Athens during the Turkish-Greek war in 1897 and returned to Germany via Istanbul. The book published in Zurich in 1905 reflects the scenes of the battle viewed from the Greek front; and the writer's favorite impressions about the Turkish people and Istanbul in general.

Europe↗
PubMed1999

[Degeneration theory and clinical psychiatry in restoration Spain (Spanish)].

Spanish historiography on degenerationism has focused on topics such as criminality, alcoholism, or its influence on naturalistic literature. From this perspective the lack of studies on how this theory affected psychiatrists in Spain is noteworthy. The aim of this paper is to analyze the relationship between clinical psychiatry and degenerationism. We stress three topics: morbid heredity and the nature of degeneration, physical and psychic stigmas, and the boundaries of degenerationism. To this end we examine different sources that include articles in the medical press, pamphlets and psychiatric treatises.

Genetic Diseases, Inborn↗
PubMed1999

A bibliographical study on Shutei Nakagawa's "Mayaku-ko" (a collection of anesthetics and analgesics)--a comparism of four manuscripts.

The greatest achievement of Seishu Hanaoka, one of the greatest surgeons in the Edo period, was the innovation of an oral general anesthetic called "Mafutsu-San" and its clinical application, however, the detailed circumstances of the innovation remain unkown to us. Shutei Nakagawa, a close friend of Hanaoka, wrote a small pamphlet entitled "Mayaku-ko" in 1796. This brochure is very important for clarifying the process of Hanaoka's study on the general anesthetic. At present I have found four manuscripts of "Mayaku-ku" which are in the Fujikawa Library of Kyoto University, Soda's Library (Personal Library), the Kyo-u Library of Takeda Pharmaceutical Company, and Matsuki's Library (Author's Library). They are classified bibliographically into two groups. The one includes two manuscripts of the Fujikawa Library and Soda's Library, which describe twenty prescriptions. The other two are the manuscripts of Kyo-u and Matsuki's Libraries describing only fourteen recipes. Among them, the Fujikawa's manuscript is the best, because it has a postscript by Yakushi Mori who transcribed this manuscript from the orginal by Shutei Nakagawa. The Fujikawa manuscript has four illustrations of plants in the end of the manuscript which the other three manuscripts lack. As the original manuscript by Nakagawa was lost in a fire in 1867, it is possible to make an accurate reproduction of the original by bibliographical comparison of four extant manuscripts.

Analgesia↗
PubMed1993

[Alcoholism and reformism in restoration Spain].

The number of medical pamphlets dealing with the problem of alcoholism, especially in the working classes, increased during the Restoration. At the same time, the State began to show concern about establishing social policies directed at improving the life-style of the proletariat and at their moralization. This study is attempting to establish the relationship that existed between these two phenomens via the debate about the social causes of alcoholism. The controversy about the closing of taverns on Sundays, developed between the Partido Socialista Obrero Español (Spanish Socialist Party) and certain sectors of the bourgeoisie synthesize the problem to be addressed.

Alcoholism↗
PubMed2001

Legume promotion in counselling: an e-mail survey of dietitians.

Little is known about dietitians current practice in counselling clients about the use of legumes in a low fat, high fibre diet. An exploratory e-mail questionnaire was sent to members of Dietitians of Canada to assess: dietitian use and preferences for legumes, dietitian practice, opinions about clients attitudes and preferences, and resource needs. Counsellors (n=256) had high personal use of legumes (64% > or = 1 serving/week) and frequently recommended legumes in counselling. The legumes most preferred by respondents and their clients were: peanuts, kidney beans, split peas, chickpeas, and lentils. Respondents often recommended canned bean products (76%) and tofu (61%), but other legume grocery products were less often recommended. The most common client issues identified were: flatulence (87% agreed), lack of familiarity (85%), and knowledge of preparation (82%). Dietitians were not satisfied with current resources to support practice, especially those respondents providing primarily clinical counselling services. The most requested resources were: recipes (90%), pamphlets (82%), food demonstrations (75%) and Internet sites (63%). Client level research is now needed to confirm the importance of the issues identified and to develop and test strategies for legume promotion in counselling.

Attitude of Health Personnel↗
PubMed2001

Issues for military women in deployment: an overview.

The stresses of deployment affect both sexes, but some are either mildly or markedly different for women. These include certain female health and gynecological issues, nursing, and pregnancy. Separation from small children, isolation, the possibility of sexual assault, and risks of combat or being taken hostage are concerns for both genders. All of these issues should be addressed before and during deployment to ensure optimal individual and unit functioning and improve retention. Gynecological infections, redeployment for abnormal Papanicolaou smears, and pregnancy while on deployment can be avoided with proper hygiene and planning. There are resources available in pamphlet form, electronically, and on CD-ROM to help prepare service members, leaders, and health care personnel. Improvements in the ability to maintain personal hygiene and to communicate home should benefit both sexes.

Contraception↗
PubMed2001

[Cooperative medical care by physicians of general hospitals and psychiatrists of an alcoholism treatment unit in Mie Prefecture].

Clinical practice of psychiatric liaison with physicians is the first step for an early treatment of alcohol dependence. Screening patients with alcohol dependence in general hospitals, carrying out intervention, and referring them to psychiatric specialists are running smoothly by the cooperation of member of the Mie Association for the Study of Alcohol-related Diseases. This association is being conducted by managers constituted of doctors, nurses, and medical social workers and the meeting is held every 6 months at district general hospitals to achieve three objectives; 1) evoking a sense of responsibility for alcoholic patients in the mind of general hospital staffs, 2) developing a network for psychiatric liaison with physicians to care patients of their alcohol dependence, and 3) keeping up activities of the association. We have already held the regular meeting 12 times, and prepared pamphlets for screening alcohol misuse and for early intervention. A course for learning skills of early intervention in this summer won the favor of participants. Through case conference of alcoholism and full accounts of the experiences given by recovered patients or their families, meeting attendants know patients' distress, families' sorrow, and their delight brought by the recovery, and are motivated to assist patients with alcohol dependence. Thus, "Spirit to Spirit" is a keyword to develop a network of the cooperative medical care for supporting patients with alcohol dependence. Referral of alcoholic patients to psychiatrists and/or psychiatric liaison therapy is promoted by a reliable, faithful, and face to face relationship between physicians and psychiatrists. Physicians' learning the skill for early intervention in alcohol dependence is followed by an increase in referral of patients to psychiatrists, and which suggests the importance of providing teaching and training of medical care for alcohol dependence to medical staffs including doctors of emergency care units, orthopedics, obstetrics, and dentistry. Therefore, systematic tools for screening alcohol dependence in general practice, and for referring patients to psychiatrics after brief intervention are needed to be prepared under the leadership of a learned society. Popularizing the skill of brief intervention in general medical practice is also indispensable for advising alcoholic patients about changing their drinking pattern or abstinence.

Alcoholism↗