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A community-based program to facilitate dental care for senior citizens.

This article presents findings of a one-year trial which examined a community-based program in Clinton County, Indiana, to help facilitate entry of senior citizens into the oral health care delivery system. A multifaceted approach addressed the senior citizens' limited knowledge of oral health care, personal barriers to obtaining dental services, and the community's concern for the health of older citizens. Program components included oral health education (newspaper articles, presentations, pamphlet distribution), personalized patient motivation ("Bring-a-Friend" campaign), and oral health screenings (public screenings and "Senior Day at the Dentist"). During the study year, 345 patients visited the dentist, compared to 179 in the baseline year. Ninety-three participated in the two "Senior Day" screenings, and 53 percent of the total 134 screening patients returned for follow-up care. Given its experimental nature, the program was a success.

Aged↗

Differential diagnosis and psychopharmacology of dual disorders.

There are multiple potential interactions of substances of abuse with psychiatric illnesses. The individual agents, the stage of abuse, withdrawal, or recovery, and the patient's psychiatric illness must be considered as an integrated whole to ascertain the appropriate interventions. Polysubstance abuse can cause still more complicated interactions. Assessment of differential treatment needs for both the psychiatric illness component and the substance use disorder component permits both elements to be approached, often simultaneously, and can facilitate treatment of both. Ignoring either component can lead to inappropriate treatment or exacerbation of illness. The high rate of comorbidity of chemical dependence and other psychiatric illnesses is intriguing in light of studies that demonstrate vulnerability to drug abuse associated with specific alleles of the dopamine D2 receptor gene in some families. It is hoped that further investigations will shed light on the complex interactions and associations between chemical dependency and other psychiatric illnesses and result in new treatment strategies for both. In the past, many substance abuse treatment programs used to emphasize the complete cessation of all medications including some potentially beneficial prescription medications. This was likely because of previous excessive prescription by physicians of sedatives or benzodiazepines. Increasingly, recovery programs support intelligent, responsible use of nonaddictive psychiatric medications, and AA World Services prints a pamphlet supporting such physician-supervised use. Conversely, psychiatrists previously frequently overlooked or neglected diagnosis and treatment of chemical-dependency disorders. Greater efforts are needed to focus equal energy on diagnosis and treatment of chemical-dependency disorders in "psychiatric" populations. Many studies show that physicians neglect to collect adequate information and are not sufficiently aggressive in referring patients to chemical dependence treatment programs. By combining knowledge and appropriate therapeutic interventions from both psychiatric and addiction treatment fields, the needs of the dually diagnosed patient can be met more adequately.

Adult↗

Shooting off fireworks: the successes and failures of an intensive, broad-based AIDS awareness campaign.

Broad-based AIDS awareness campaigns often involve media advertisements, posters and/or pamphlets intended to address a specific concern related to HIV/AIDS. They focus on safer sex, prevention for young adults, women's issues in relation to HIV, etc. During the autumn of 1991 a group of Manitoba AIDS organizations came together to organize, promote and deliver an eight-week AIDS Awareness Campaign that would address a broad spectrum of HIV/AIDS-related issues. Instead of attempting to solidify one prevention message, this campaign attempted to satisfy a variety of organizational agendas. Although it achieved its goals and was a very visible, but short-lived exercise in AIDS awareness, this campaign proved to be taxing on local community-based resources.

Acquired Immunodeficiency Syndrome↗

[A study of ambulatory treatment for pulmonary tuberculosis in foreigners residing in Japan].

We studied 130 cases of pulmonary tuberculosis in foreigners residing in Japan to obtain the results as follows; 1. Of the cases of pulmonary tuberculosis in foreigners who are registered and receiving treatment in Japan, 20.3% were treated at three dispensaries of the Japan Antituberculosis Association in Tokyo. 2. The nationality of the cases treated was China in more than half of them, followed by the Republic of Korea. 3. The number of days taken from entry into Japan to the start of treatment was about 11.4 months; 0.9% of the total number of cases examined by chest radiophotography required medical treatment. 4. Their living conditions in Japan according to questionnairing are: 56.2% have jobs in Japan; working hour, 4.99 +/- 1.19 hours a day; 64.4% take night work; 57.6% work in food/drink service industry; living space is 12.5 m2; 52.4% share the same house with other persons, living together with 1.6 persons. 5. As for the type of illness at the start of treatment, GAKKAI classification type III accounted for 90% and spread 1 83.8%. GAKKAI classification type II accounted for 10%, consisting of many relatively mild cases. 6. The defaulter rate was high at 40.8%. The reason for defaulting was broken down to discontinuation on his own 68%, repatriation 15% and side-effects 19%. The time to default was average 3.2 +/- 3.1 months after the start of treatment. They defaulted 1.2 +/- 0.4 times on the average. 7. To reduce the defaulter rate to the minimum in treating the foreigners residing in Japan, the following may be needed. a. To give guidance on the regimen including the need of treatment and risk associated with discontinuation of treatment at the first visit. b. Measures to reduce the amount to be born by the individual in the medical expenses. c. Preparation of a pamphlet for therapeutic guidance in foreign languages.

Adult↗

[Freud and Fliess at Achensee].

Freud has always emphasized the importance of self-analyzing one's own slips. When Freud met Fliess at lake Achensee he could not remember that Fliess had called his attention to the importance of bi-sexuality in 1897. In answer to it, Freud analyzed himself, and realised that he was going to deprive his best friend Fliess of his convictions. However, Freud was satisfied with the comment that he became more tolerant of other researchers. However, he did not get to the root of the problematic nature of his ambition. Thus, a new Freudian slip was to be expected. Freud had repressed the visit O. Weininger had paid to him with the early manuscript on ¿Sex and Character¿ in 1901. Only precise hints of Fliess helped Freud to overcome his amnesia and became aware of the facts repressed. But even now Freud did not get to the root of the problematic nature of his ambition. He was satisfied with forgetting all private informations of Fliess as soon as possible. In 1924 this resulted in a new Freudian slip (Wittels). Freud could have spared all these slips by digesting his experience at lake Achensee completely (all polemic pamphlets of the year 1906 would not have appeared at least).

Awareness↗

Managing diarrhoea. Current thinking.

This article reviews the assessment of a patient presenting with diarrhoea. Brief comments are provided about certain specific causes of diarrhoea. Recent changes are highlighted and reference is made to some of the available booklets and pamphlets about the various causes of diarrhoea. This educational material may be useful to both general practitioners and their patients.

Celiac Disease↗

[Medicine and humanism: insights of the Nürnberg city physician Theodericus Ulsenius regarding Morbus Gallicus].

The Nuremberg physician and humanist Theodericus Ulsenius (c. 1460-1508) was the author of two works on the so-called Morbus Gallicus. In 1496 he published a Vaticinium in epidemicam scabiem, and he also wrote fifty aphorisms, entitled Cura mali francici. In this article I will characterize Ulsenius' ideas and compare these to the measures the Nuremberg town government took to diminish the dangerous effects of the epidemic. In the function of official town physician, Ulsenius was one of the chief advisers and executives of the Nuremberg health policy. As the 'Ratsverlässe' (records of the town-council meetings) give detailed information, the reactions of senate and physicians can be followed from day to day. The Vaticinium a poem of 100 hexameters was printed at the office of Hans Mair and presented as a pamphlet with a woodcut from the workshop of Albrecht Dürer. The verses refer to a dream of the poet, in which the God Apollo addresses him and talks about the terrible disease. The origin and symptoms of the illness are discussed extensively, in accordance with the prevailing medico-astrological conceptions. Nevertheless, the poem ist not a medical piece of work, but a literary-styled and humanistically appropriate description of the recent epidemic, meant for fellow members of the German respublica litteraria. Like most of Ulsenius' writings, the Cura mali francici only survived as a copy made by his colleague Hartmann Schedel. It seems that the author had different types of audience in mind. The aphorisms refer to the Aphorisms of his great example, the famous Ancient medical doctor Hippocrates of Kos. The addresses of the Cura are obviously medical professionals: the physician in the towns harassed by the Morbus Gallicus and especially the medical professors who hat to lecture on the new ailment.

Disease Outbreaks↗

Glucose monitoring as a guide to diabetes management. Critical subject review.

PURPOSE: To encourage a balanced approach to blood glucose monitoring in diabetes by a critical review of the history, power and cost of glucose testing. DATA SOURCES: The Cambridge Data Base was searched and was supplemented by a random review of other relevant sources, including textbooks, company pamphlets, and laboratory manuals. STUDY SELECTION: Keywords used were "glucosuria diagnosis," "blood glucose self-monitoring," "glycosylated hemoglobin," and "fructosamine" for the 10-year period ending 1992, restricted to English language and human. DATA EXTRACTION: About 200 titles were retrieved and reviewed according to the author's judgment of relevance. FINDINGS: "Snapshot tests" (venous and capillary blood glucose) and "memory tests" (urine glucose, glycated hemoglobin fractions and fructosamine) must be employed according to individual patients treatment goals. Day-to-day metabolic guidance is facilitated by capillary blood glucose testing for patients receiving insulin and by urine glucose testing for others. Capillary blood glucose testing is mandatory in cases of hypoglycemia unawareness (inability to sense hypoglycemia because of neuropathy) but is not a substitute for a knowledge of clinical hypoglycemia self-care. Criteria by reason (clinical judgement and cost effectiveness) must be separated from criteria by emotion (preoccupation with technology and marketing). No randomized studies show that any of these tests consistently improve clinical outcome. Optimal metabolic control and cost savings can be expected from a rational selection of tests.

Blood Glucose↗

Pediatric injuries: parental knowledge, attitudes and needs.

OBJECTIVE: To understand current parental knowledge, attitudes and information needs about childhood injuries. METHOD: Telephone survey of 1,516 parents in Metropolitan Toronto and Barrie. RESULTS: Over half of the parents knew that injuries were the leading cause of death and about 70% believed that injuries were the most preventable of major health disorders. However, most parents were not particularly concerned, and most had limited understanding of the major causes of injury. Traditional modes of receiving safety information by obtaining pamphlets from doctors' offices or drug stores and through media coverage were preferred. CONCLUSIONS: Although parents were aware of the risk of general childhood injury, they need to be educated about specific injury risks and effective countermeasures. A concerted and thoughtful effort is needed to market safety information for parents in Ontario.

Adolescent↗

Cervical cytology screening. How can we improve rates among First Nations women in urban British Columbia?

OBJECTIVE: To determine Pap smear screening rates among urban First Nations women in British Columbia; to identify facilitators and barriers; and to develop, implement, and evaluate specific interventions to improve Pap smear screening in Vancouver. DESIGN: Computer records of band membership lists and the Cervical Cytology Screening Program registry were compared to determine screening rates; personal interviews and community meetings identified facilitators and barriers to urban screening programs. A community advisory committee and the project team collaborated on developing specific interventions. SETTING AND PARTICIPANTS: Purposive sample of British Columbia First Nations women, focusing on women living in Vancouver. INTERVENTIONS: Poster, art card, and follow-up pamphlet campaign; articles in First Nations community papers; community meetings; and Pap smear screening clinics for First Nations women. MAIN OUTCOME MEASURES: Pap smear screening rates among BC First Nations women according to residence and reasons for not receiving Pap smears. RESULTS: Pap smear screening rates were substantially lower among First Nations women than among other British Columbia women; older women had even lower rates. No clear differences were found among First Nations women residing on reserves, residing in Vancouver, or residing off reserves elsewhere in British Columbia. Facilitators and barriers to screening were similar among women residing on reserves and in Vancouver. Many First Nations women are greatly affected by health care providers' attitudes, abilities to provide clear information, and abilities to establish trusting relationships. CONCLUSIONS: Family physicians are an important source of information and motivation for Pap smear screening among First Nations women.

Adolescent↗

[Changes in nurses' knowledge and attitudes regarding AIDS in Mie Prefecture, Japan].

In 1990, we conducted a questionnaire survey showing that many nurses had incorrect knowledge of AIDS resulting in inappropriate attitudes toward AIDS patients. Following the first survey conducted in 1990, nurses were given various forms of AIDS education. The effectiveness of the AIDS education requires assessment. Therefore a second questionnaire survey was performed in 1993 to assess changes in nurses' knowledge and attitudes regarding AIDS. The same questionnaire as used in the first survey was sent to a random sample of nurses working at general hospitals in Mie Prefecture, Japan. The questionnaire covered knowledge of AIDS, psychological responses, attitudes and conduct around infected persons and measures against AIDS. Results of both questionnaire surveys showed that the majority of nurses acquired their knowledge predominantly from the mass media, and a large number of nurses worried that AIDS would spread in Japan. Almost half of the nurses were worried that they might be infected with AIDS. The second survey showed that nurses who acquired knowledge of AIDS from printed material, pamphlets and other educational resources, including lectures had increased. In 1993, many more nurses had accurate knowledge compared to the number in the first survey. In 1993 the number of nurses who discriminated against AIDS patients and HIV-infected persons had decreased.

Acquired Immunodeficiency Syndrome↗

150 years of the New York Academy of Medicine: a series of exhibitions.

As the New York Academy of Medicine celebrates its 150th year as a leader in the field of urban health, it is instructive to review the events and decisions that influenced and shaped it. Since its inception, the Academy has taken an active role in lobbying state and local governments to enact more-effective public health laws and in educating the public about improving health conditions. During 1996 and 1997, the Academy Library's Historical Collections is mounting a series of six exhibitions that are intended to tell the story of public health in New York as influenced by the New York Academy of Medicine. The story will be told using printed books, pamphlets, posters, photographs, and manuscripts drawn from the Library's collections, as well as the Academy's archives. Each exhibition will highlight the Academy's accomplishments in the subject areas presented. In this article, we summarize all six of the exhibitions and offer an in-depth look at the first two exhibitions.

Disease Outbreaks↗

Occupational safety & health administration. Building partnerships.

1. The Office of Occupational Health Nursing, within the Occupational Safety & Health Administration (OSHA), actively advocates for workers and occupational health nurses. 2. Although an enforcement agency by law, OSHA has and is in the process of building bridges to the regulated community through its cooperative development of programs intended to enhance employer efforts for improving and maintaining employee health and workplace safety. 3. OSHA's service of consultation is geared toward the small employer seeking assistance in the recognition and correction of workplace hazards, while improving worksite health and safety programs. Voluntary Protection Programs participation, the recognition of exemplary larger employers, often leads to improvements in employee safety motivation while improving product quality, worker productivity, and corporate profits. 4. OSHA produces a wealth of publications, pamphlets, audiovisual, computer access programs and other documents designed to ease compliance while providing a foundation to the understanding of workplace health and safety.

Humans↗

Reaching smokers with lower educational attainment.

Between 1977 and 1994, smoking rates declined among men and women, but the decline was steeper for men. While smoking rates fell among people at all levels of education, the smallest drop was among those with high school graduation or less, particularly women. For those who had stopped smoking, health concerns had been the overriding factor. Smokers with lower education reported encountering fewer smoking restrictions in their daily activities than did those with higher education. All smokers cited the mass media as their major source of information about smoking, but those with lower education reported the mass media less often than did smokers with higher levels of attainment, and were less likely to obtain information from books, pamphlets or magazines. In addition, smaller percentages of smokers with lower education recalled printed warnings about heart disease on cigarette packages. Variations in the decline of smoking suggest that health promotion and smoking cessation programs should consider sex and educational differences when targeting the smoking population. Differences in rates of smoking among people aged 20 and over were examined by educational attainment using selected health surveys conducted between 1977 and 1994. A Health Canada-sponsored supplement to Statistics Canada's National Population Health Survey was used for data on other aspects of smoking such as cutting back or attempting to quit, sources of health information, and awareness of smoking restrictions and cigarette package warnings.

Adult↗

Earliest evidence for arthrogryposis multiplex congenita or Larsen syndrome?

A sixteenth-century illustrated pamphlet from Great Britain suggests that documentary evidence may permit accurate diagnosis of pathological conditions in earlier societies. The document is of particular importance, since the presented congenital abnormalities, including cleft lip, spina bifida cystica, genu recurvatum, and talipes deformity are reported rarely in archaeological skeletal material. It is suggested that the combination of abnormalities may represent the earliest case of arthrogryposis multiplex congenita or Larsen syndrome.

Abnormalities, Multiple↗

Canadian physicians' attitudes about and preferences regarding clinical practice guidelines.

OBJECTIVE: To assess Canadian physicians' confidence in, attitudes about and preferences regarding clinical practice guidelines. DESIGN: Cross-sectional, self-administered mailed survey. PARTICIPANTS: Stratified random sample of 3000 Canadian physicians; 1878 (62.6%) responded. SETTING: Canada. OUTCOME MEASURES: Physicians' use of various information sources; familiarity with and confidence in guidelines; attitudes about guidelines and their effect on medical care; rating of importance of guidelines and other sources of information in clinical decision-making; rating of importance of various considerations in deciding whether to adopt a set of guidelines; and rating of usefulness of different formats for presenting guidelines. MAIN RESULTS: In all, 52% of the respondents reported using guidelines at least monthly, substantially less frequently than traditional information sources. Most of the respondents expressed confidence in guidelines issued by various physician organizations, but 51% to 77% were not confident in guidelines issued by federal or provincial health ministries or by health insurance plans. The respondents were generally positive about guidelines (e.g., over 50% strongly agreed that they are a convenient source of advice and good educational tools); however, 22% to 26% had concerns about loss of autonomy, the rigidity of guidelines and decreased satisfaction with medical practice. Endorsement by respected colleagues or major organizations was identified as very important by 78% and 62% of the respondents respectively in deciding whether to adopt a set of guidelines in their practice. User friendliness of the guidelines format was thought to be very important by 62%; short pamphlets, manuals summarizing a number of guidelines, journal articles and pocket cards summarizing guidelines were the preferred formats (identified as most useful by 50% to 62% of the respondents). CONCLUSIONS: Canadian physicians, although generally positive about guidelines and confident in those developed by clinicians, have not yet integrated the use of guidelines into their practices to a large extent. Our results suggest that respected organizations and opinion leaders should be involved in the development of guidelines and that the acceptability of any proposed format and medium for guidelines presentation should be pretested.

Attitude of Health Personnel↗

[Drug consultation and at home care--the present situation and the point at issue in our hospital].

We began drug consultation in our hospital and at home care about one year ago, because of progress in the quality of medical care. As the method for drug consultation, we tried to educate patients using our own pamphlets. It was assumed that the education was important not only for the patients but also for their family. Again, it was assumed that the usefulness of a conference with doctors, nurses, MSW and us made for better compliance in taking drugs, assured early detection of side effects and better management of the disease. With home care, it is supposed that the drug consultation will be carried out by clinical pharmacists will make for progress in the quality of medical care.

Home Care Services, Hospital-Based↗

Effectiveness of a structured communication program for family members of patients in an ICU.

BACKGROUND: In ICUs, an essential component of caring for patients' families is providing information about the patient's status. Nevertheless, interruptions by family members requesting information create an additional burden for nursing staff. OBJECTIVES: To test a structured communications program for family members to determine whether the program would increase family members' satisfaction with care, meet their needs for information better, and decrease disruption for the ICU nursing staff caused by incoming telephone calls from patients' family members. METHODS: The study used a two-group, pretest-posttest quasi-experimental design. The sample consisted of 30 family members of patients in a medical ICU (experimental group, n = 15; control group, n = 15). The intervention consisted of a structured communication program consisting of three components: (1) a discussion with a nurse approximately 24 hours after admission of the patient, (2) an informational pamphlet given at the time of the discussion, and (3) a daily telephone call from the nurse who was caring for the patient that day. RESULTS: The number of incoming calls from family members was significantly lower in the experimental group than in the control group. In the experimental group, satisfaction with care increased significantly from pretest to posttest, as did the members' perception of how well their information needs were being met. CONCLUSIONS: The intervention reduced the number of incoming calls from family members, without compromising family members' satisfaction with care or how well their information needs were met.

Adult↗