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PubMed2006

Increased prevalence of concentric left ventricular hypertrophy in African-Americans: will an epidemic of heart failure follow?

Left ventricular hypertrophy (LVH), used in this review to denote abnormally increased left ventricular (LV) mass, is an important cardiac trait because of its association with numerous adverse cardiovascular outcomes including myocardial infarction and heart failure. LV mass is typically assessed by noninvasive cardiac imaging (echocardiography or MRI); electrocardiography is an insensitive measure. There are two predominant types of hypertrophy: concentric, where LV wall thickness is increased relative to cavity dimensions, and eccentric, where LV wall thickness is not increased relative to cavity dimensions. Several large studies indicate that the prevalence of concentric LVH is higher in African-Americans versus whites. Although there are data to suggest that concentric LVH results in systolic heart failure in animal models, such data are lacking in humans. How concentric LVH affects the prevalence of systolic and diastolic heart failure in African-Americans needs further study. Given the large burden of LVH among African-Americans, such data are needed to estimate the expected burden and type of heart failure which will occur in the future in this population.

Adult↗
PubMed1988

Cost-effectiveness prospects of picture archiving and communication systems.

PAC (picture archiving and communication) systems are widely discussed and promoted as the organizational solution to digital image management in a radiology department. For approximately two decades digital imaging has increasingly been used for such diagnostic modalities as CT, DSA, MRI, DR (Digital Radiography) and others. PACS are seen as a step toward high technology integration and more efficient management. Although the acquisition of such technology is investment intensive, there are well-founded projections that prolonged operation will prove cost justified. Such justification can only partly be derived from cost reduction through PAC with respect to present department management--the major justification is preparation for future economic pressures which could make survival of a department without modern technology difficult. Especially in the United States the political climate favors 'competitive medicine' and reduced government support. Seen in this context PACS promises to speed the transition of Health Care Services into a business with tight resource management, cost accounting and marketing. The following paper analyzes cost and revenue in a typical larger Radiology Department, projects various scenarios of cost reduction by means of digital technology and concludes with cautious optimism that the investment expenses for a PACS will be justified in the near future by prudent utilization of high technology.

Archives↗
PubMed1991

Problems and potential of researching epidemiological transition: examples from Southeast Asia.

The concept of epidemiological transition is now quite widely recognized, if not so widely accepted. The transition appears to progress at varying speeds and to different extents spatially; it seems that there can be considerable international, regional and local variations in its progress. The paper examines this contention in the case of a number of countries in Southeast Asia, principally Hong Kong, Malaysia and Thailand. Drawing on evidence from this region, the paper highlights the importance when researching epidemiological transition of the time period under consideration; socio-cultural variations; the nature and quality of data, and spatial scale. It makes some suggestions as to the potential of the concept of epidemiological transition in health care planning and development studies.

Asia, Southeastern↗
PubMed1996

Child survival: physical vulnerability and resilience in adversity in the European past and the contemporary Third World.

Infant and child physical vulnerability is demonstrated by the extremely high mortality levels in these age groups in the pre-modern West and parts of the contemporary Third World. Some children, such as females or later additions to the family, are subject to disproportionately high mortality risk. In spite of the age-old vulnerability of young children, disproportionate gains have been made in reducing their mortality in modern times. This has been a product of social and individual change, government intervention and biomedical research. These advances exhibit during crises greater resilience to reversal than might be anticipated. Rarely do infant and child mortality levels return more than a fraction of the way to the original levels. The explanation is irreversible changes to individuals and society and the persistence of health knowledge even when health facilities are paralysed.

Adolescent↗
PubMed2004

Health sector policy in the first decade of Nepal's multiparty democracy. Does clear enunciation of health priorities matter?

Nepal experienced a significant political regime shift in 1990 from the partyless Panchyat system to the present multiparty form of democracy. While political instability existed in the decade of the 1990s, reflected in the approximately one government per year, there had been continued enunciation of health policy priorities toward the rural sector, as reflected in the Nepal National Health Policy, 1991 (NHP (1991)) and subsequent plans. The objective of the paper is to assess whether clear enunciation of health priorities have translated into beneficial health outcomes, reflected in reduction of the child death rate, child morality rate, infant mortality rate and increase in the life expectancy rate. This question is assessed empirically over the 10-year period of fiscal year 1989/1990 to 1999/2000 using mainly secondary data published by His Majesty's Government of Nepal (HMG/N), through the perspectives of input-output model and extension of health services, along with an indicative regression of a Nepalese health production function. The results (i.e. empirical observations) suggest that while there have been clear enunciation of health priorities, there have not been significant positive effects on health sector outcomes. The paper ends with a number of recommendations and concludes with the necessity for effective and appropriate implementation.

Adult↗
PubMed2006

Transitions of care and changes in distressing pain.

This study employed a 22-state mortality follow-back survey to examine bereaved family members' perception of the level and pattern of distressing pain in decedents with cancer at the last two sites of care. Of the 1,578 individuals interviewed, 423 of their family members had cancer listed as the leading cause of death on the decedent's death certificate. Decedents were treated at home, hospitals, hospices, or nursing homes, with more than half of the respondents (n = 216) reporting that the decedent was at more than one site of care in the last month. Forty-two percent of decedents had distressing pain (defined as "quite a bit" or "very much") at their second to last place of care, with 40% having distressing pain at the last place. There was some variation in the degree of change depending on the transition between the second to last and last places of care. For many individuals, however, the transition to another place of care did not result in an improvement in the level of distressing pain. No significant differences were found in the change in distressing pain by transition of care. Increased attention is needed not only on how to adequately manage pain and pain-related distress but also on how to improve pain reduction measures in transitions between health care settings at the end of life.

Aged↗
PubMed2004

Rapid income growth adversely affects diet quality in China--particularly for the poor!

To study the impact of income change--specifically rapid income growth--on diet behavior over time and by socioeconomic level, we used data from a prospective study of China begun in 1989 (followed up in 1991, 1993 and 1997). The subpopulation used in this study included 5783 subjects aged 20-45 years old from 3129 households. Dietary intakes were measured using a combination of the weighing method and three consecutive 24-h recalls. Detailed income and price data were collected, and predicted household per capita income was used in multivariate longitudinal random-effects models that described the consumption of several food groups and nutrients. Income elasticity was used to measure the changes for the effects of income over time on (a) the probability of consuming any food and (b) the quantity of food consumed. The structure of the Chinese diet is shifting away from high-carbohydrate foods toward high-fat, high-energy density foods. The variation in the income effects that we uncovered indicated that important changes in income effects took place between 1989 and 1997, with the changes varying considerably by socioeconomic status. These shifts in income effects indicate that increased income might have affected diets and body composition in a detrimental manner to health, with those in low-income groups having the largest increase in detrimental effects due to increased income. Extrapolating from our estimates, higher income levels in the future could lead to the reversal of the health improvements achieved in the last two decades, if diet-related noncommunicable diseases cannot be controlled.

Adult↗
PubMed2005

Informal payments in government health facilities in Albania: results of a qualitative study.

As governments seek to expand access to quality health care services, policy makers in many countries are confronting the problem of informal payments to medical personnel. The aim of this study was to help health planners in Albania understand informal payments occurring in government health facilities. Researchers used in-depth interviews and focus groups with 131 general public and provider informants in three districts. The results suggest that factors promoting informal payments in Albania include perceived low salaries of health staff; a belief that good health is worth any price; the desire to get better service; the fear of being denied treatment; and the tradition of giving a gift to express gratitude. Members of the general public also believe informal payments create uncertainties and anxiety during the care-seeking process, while providers perceive that informal payments harm their professional reputation, induce unnecessary medical interventions, and create discontinuity of care. The study showed that focusing on the most harmful effects and targeting the most vulnerable populations may be one way to gain consensus for policy reform. Understanding citizens' and caregivers' viewpoints is an important step in designing regulatory and bureaucratic interventions.

Albania↗
PubMed2003

Mitral valve repair and replacement in northern New England.

BACKGROUND: The etiology of mitral valvular disease has changed in the last 20 years, and new techniques for the diagnosis and repair of mitral valves have been advanced. A retrospective regional study was conducted to identify changes in patient and disease characteristics and in population-based rates for mitral valve repair and replacement in northern New England. METHODS: Data from 1648 patients were collected from 5 clinical centers in Maine, New Hampshire, and Vermont between January 1, 1990, and December 31, 1999. U.S. Census data were used to calculate population-based rates. RESULTS: Total mitral valve procedures increased 2.4 times, from 8.7 to 20.6 cases/100,000/year (p(trend) = 0.004). Primary procedures increased from 6.7 to 16.9 cases/100,000/year (p(trend) = 0.014). Primary mitral valve repair procedures increased 3.7 times, from 2.4 to 8.9 cases/100,000/year (p(trend) = 0.012), whereas mitral valve replacement increased only 1.9 times, from 4.3 to 8.0 cases/100,000/year (p(trend) = 0.016). Repeat mitral valve operations did not change significantly (p(trend) = 0.810). During this period, there was a significant increase of the percentage of octogenarians (p(trend) = 0.016) and of patients with ejection fractions <40% (p(trend) = 0.012). There was a decrease in the percentage of patients with mitral stenosis (p(trend) = 0.024). CONCLUSION: In an era of a change in the etiology of mitral valvular disease and new techniques for diagnosis and repair of mitral valvular disease, regional data demonstrate substantial increased rates of mitral repair and replacement and expanded indications of older age and poorer left ventricular function.

Aged↗
PubMed1998

Fluctuations in the number and distribution of prosthodontists: 1987-1995.

PURPOSE: This article presents a review that used three ADA studies on the distribution of dentists to determine whether the number of private practice prosthodontists in the mid 1990s has kept pace with the population in the various regions and states. RESULTS: Findings indicate that between 1987 and 1991 there was a marked national increase in numbers of prosthodontists followed by a marked decrease during the first half of the 1990s. There continued to be major differences, however, in practitioner-to-population ratios in different geographic areas. Since the mid 1980s, there has been a general increase in the number of graduates from prosthetic programs, but an increasing percentage of these graduates were foreign trained dentists. CONCLUSION: There continues to be a need to determine the adequacy of the number and distribution of prosthodontists.

American Dental Association↗
PubMed1999

Stressors and concerns in teen asthma.

Adolescents are uniquely susceptible to poor outcome with asthma because of their desire for autonomy, denial of disease, preference for immediate gain rather than prophylaxis, restricted ability to control their psychosocial and physical environment, and difficult transition to health care. Tobacco smoking as well as related drug abuse and passive exposure to tobacco is a major obstacle to managing adolescent asthma, together with atopy and psychosocial problems. Recent investigations indicate that adolescents are uniquely susceptible to tobacco industry promotions and logos because of these developmental characteristics. By understanding adolescent development, behavior and peer group impact, with its spectrum from early to late adolescence, clinicians can target their educational interventions more successfully in asthma. Health care provision for the adolescent with asthma requires a multidisciplinary team spearheaded by a primary care provider with the expert guidance of an allergist, outreach nurse, mental health worker, and social service representative. This care must be negotiated with an appropriate educational plan on the basis of NHLBI guidelines to be successful. Medications should be prescribed no more than twice a day, whenever possible, in conjunction with an action plan on the basis of peak flow readings to warn the adolescent when to use more medication and when to call the clinician. The plan should empower adolescents by recognizing their need for autonomy with self-management, enabling them to have a safe and comfortable lifestyle, and being physically and mentally at ease with their peers, family, school, and work environments.

Adolescent↗
PubMed2002

On the correlation between wind speed, coarse aerosol concentration and the electrical state in the ground atmospheric layer in semi-arid areas.

Our general work has been dedicated to the problems connected with the influence of short-term changes of the atmospheric state on some medically unexplained human responses. What are the meteorological stimuli eliciting the transition between health and disease? There are many reports on the impact of humidity, winds or pollution on feelings of disease or discomfort. We suppose that the main influencing climatic factor, which could excite multiform biological reactions, is atmospheric electricity, E, whose parameters depend strongly on the content of the air column and on the meteorological conditions in this volume, especially along its ground path. A clear connection between wind speed Vw and coarse aerosol concentration N(T) with electric field intensity E exists only for limited intervals of Vw, and N(T). In these ranges, the mean correlation coefficients p(E; Vw) and p(E; N(T)) are usually up to 0.45. In quiet weather, rho is significantly larger than in the equinox seasons or in transferred weather situations. Strong winds or a considerably increased pollution level lead to fast and deep fading of E and even to principal changes in the form of its diurnal distribution from what is usual for stable atmosphere conditions, while weak air streams or a clear atmosphere have almost no influence on electric state variations.

Aerosols↗