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PubMed2003

The aging population and its impact on the surgery workforce.

OBJECTIVE: To predict the impact of the aging population on the demand for surgical procedures. SUMMARY BACKGROUND DATA: The population is expanding and aging. According to the US Census Bureau, the domestic population will increase 7.9% by 2010, and 17.0% by 2020. The fastest growing segment of this population consists of individuals over the age of 65; their numbers are expected to increase 13.3% by 2010 and 53.2% by 2020. METHODS: Data on the age-specific rates of surgical procedures were obtained from the 1996 National Hospital Discharge Survey and the National Survey of Ambulatory Surgery. These procedure rates were combined with corresponding relative value units from the Centers for Medicare and Medicaid Services. The result quantifies the amount of surgical work used by an average individual within specific age groups (<15 years old, 15-44 years old, 45-64 years old, 65+ years old). This estimate of work per capita was combined with population forecasts to predict future use of surgical services. RESULTS: Based on the assumption that age-specific per capita use of surgical services will remain constant, we predict significant increases (14-47%) in the amount of work in all surgical fields. These increases vary widely by specialty. CONCLUSIONS: The aging of the US population will result in significant growth in the demand for surgical services. Surgeons need to develop strategies to manage an increased workload without sacrificing quality of care.

Adolescent↗
PubMed2005

Impact of rapid socio-economic changes on teenage pregnancies in Estonia during 1992-2001.

BACKGROUND: Major socio-economic changes, including health care reforms and changes in the school curriculum, took place in Estonia after the country regained its independence in 1991. These changes affected people's reproductive behavior in many ways. In this article, the impact of the changes on the reproductive behavior of teenage girls, measured by adolescent fertility and abortion rates between 1992 and 2001, is analyzed. METHODS: National data on abortions and births were obtained from official medical statistics, particularly from the Estonian Abortion Registry and the Estonian Medical Birth Registry. Female population denominators for the age group 15-19 were obtained from the Statistical Office of Estonia. RESULTS: In teenagers, the birth rate decreased more than two times, from 49.7 per 1000 in 1992 to 23.8 per 1000 in 2001. The abortion rate per 1000 decreased from 55.5 in 1992 to 30.4 in 2001. Compared with all women of fertile age (15-49 years), at the beginning of the decade, teenagers decided more often to have a baby, and, at the end of the decade, they decided more often to terminate the pregnancy. Two-thirds of all pregnancies in teenagers end in abortion--either legally induced abortion (legal abortion and therapeutic abortion) or spontaneous abortion. In 2001, the abortion ratio was 116.4 among ethnic Estonians and 147.9 among non-Estonians. CONCLUSIONS: The case in Estonia again proves that the availability of information, contraceptives, services and education, and the existence of other goals in life besides childbearing, have an impact on teenage birth and abortion rates. Successful health promotion activities should take into consideration the differences in the reproductive behavior of different ethnic groups.

Abortion, Induced↗
PubMed2005

Effects of long-term treatment with oxytocin in chronic constipation; a double blind, placebo-controlled pilot trial.

BACKGROUND: Oxytocin and its receptor have been found throughout the gastrointestinal (GI) tract, where it affects gut function. Clinically, we have noticed an improvement of bowel habits during lactation in constipated women. The aim of this study was to examine whether oxytocin has an effect on bowel symptoms and psychological well being in women with refractory constipation. METHODS: Fifty-nine women with refractory constipation were included in a double blind, multicentre study. After a 2-week run-in period, they were randomly allocated to nasal inhalation of either placebo or oxytocin treatment twice daily for 13 weeks, followed by a 2 weeks, posttreatment period. The patients completed a questionnaire every day concerning bowel habits, abdominal pain and discomfort, and Gastrointestinal Symptoms Rating Scale (GSRS) and Psychological General Well-being (PGWB) twice during the study; namely, during the baseline period and at the end of the treatment period. RESULTS: Both oxytocin and placebo led to improvement of the constipation according to the GSRS and led to improvement in the sensation of incomplete evacuation and anorectal obstruction, without significant differences between the groups. Abdominal pain and discomfort responded weakly to oxytocin, with no effect of the placebo. In a subgroup of patients with IBS and concomitant depression, a weak improvement in depressed mood was observed after oxytocin administartion. CONCLUSION: Nasal administration of oxytocin had no significant advantage over placebo concerning an effect on constipation. However, it seems to have a positive effect on abdominal pain and discomfort and depressed mood. These findings should be further explored.

Adult↗
PubMed2005

Prevalence of obesity in Turkey.

Obesity and overweight are increasing in Turkey according to the field surveys that were carried out a decade apart (TEKHARF 1990 and 2000). The overall prevalence of obesity in adults was 18.6% in the year 1990. Ten years later in 2000, the prevalence was 21.9%, which shows a relative increase rate of 17.7%. As it is true for most of the countries, overweight is more common in men and obesity is more prevalent among women in Turkey.

Adolescent↗
PubMed2005

The elderly people of post-Soviet Ukraine: medical, social, and economic challenges.

Over the past 14 years, since Ukraine became an independent nation, the country has made major strides toward achieving political and economic reforms, exemplified by the recent populist uprising for fair and free elections. Despite these successes, many challenges still lie ahead, particularly in the area of health care for older people. The average life expectancy in Ukraine is only 67 years, and those who achieve old age often live in poverty. Women are expected to retire from their professions at age 55 and men at 60. Pensions are so low that retirees are often forced to take laborious jobs on the streets. Because of deficiencies in medical education, deteriorating hospital facilities, a lack of modern medications and supplies, and inadequate physician payment mechanisms that breed corruption, many elderly people mistrust the medical system and often turn to folk medicines and Eastern medical practices to treat their illnesses. By understanding the expectations and former medical practices of elderly patients who have emigrated from Ukraine, Western physicians will be better able to meet their emotional and medical needs.

Aged↗
PubMed1994

The dynamic range of neonatal heart rate variability.

INTRODUCTION: Although it is generally appreciated that heart rate variability is low during severe illness, the extent, time course, and mathematical characteristics of heart rate variability during transitions between health and illness have not been systematically examined. The purpose of this study was to analyze heart rate variability in newborn infants during a rapid recovery from severe respiratory and circulatory failure. METHODS AND RESULTS: From prolonged ECG recordings, we evaluated heart rate variability in the time domain (mean, relative change, and coefficient of variation of RR intervals), in the frequency domain (using power spectra of the time series of RR intervals), and using a neural network. Qualitatively, RR interval plots showed little heart rate variability during severe illness but became "noisier" during recovery. Quantitatively, recovery was marked by twofold to threefold increases in time-domain parameters, by eightfold increases in frequency-domain parameters, and by more than 20-fold increases in a neural network measure. Time-domain and frequency-domain measures were correlated, but not strongly. Heart rate variability reached stable levels by 4 to 5 days. Heart rate did not change dramatically. CONCLUSION: Recovery from severe neonatal illness is accompanied by large and rapid increases in heart rate variability, but not by large changes in heart rate. This increase can be effectively assessed in the time domain, in the frequency domain, and by using a neural network.

Cardiovascular Diseases↗
PubMed2005

Geriatric dentistry education in European dental schools.

As the numbers of elderly adults continue to grow within European populations, the need for dental students to be trained in the management of geriatric patients becomes increasingly important. Many dental schools have developed training programmes in geriatric dentistry in response to the changing oral health needs of older adults. The purpose of this on-line survey was to identify the current status of geriatric dentistry education in European dental schools. A questionnaire relating to the teaching of geriatric dentistry was posted on the Internet, and 194 dental schools in 34 European countries were invited to participate. Data from completed questionnaires were submitted to the investigators via email from 82 schools in 27 countries (42% response rate). Thirty-six percent of schools offered a specific geriatric dentistry course that included didactic teaching or seminar groups, 21% taught geriatric dentistry by means of organised presentations in the curriculum, and 36% taught the subject by occasional lectures. 7% of schools did not teach geriatric dentistry at all. A clinical component to the geriatric dentistry curriculum was reported by 61% of schools and 18% reported operating a specific geriatric dentistry clinic within the school. Of those providing clinical geriatric dentistry training, it was provided within the school in 45% of cases, with a further 29% of schools providing training both within the school and at a remote location. Seven percent of schools operated a mobile dental clinic for treating geriatric patients. Twenty-eight percent of schools had a geriatric programme director or a chairman of a geriatric section and 39% indicated that they plan to extend the teaching of geriatric dentistry in the future. Geriatric dental education has clearly established itself in the curricula of European dental schools although the format of teaching the subject varies widely. It is of concern that geriatric dentistry was not taught at all in 7% of schools. No data are available concerning whether or not geriatric dentistry is taught in the 58% non-responding schools.

Aged↗
PubMed2002

Asia's family planning programs as low fertility is attained.

The dramatic demographic changes in Asia during the three decades from 1970 to the end of the twentieth century were matched by major changes in government population policies and programs. Fertility declines occurred in widely different economic, sociocultural, and political settings. The extent to which they were attributable to family planning programs, established in most countries of the region by 1970, is hotly debated. The 1970s were the heyday of family planning programs, which were created in a climate of urgency because of concerns over the "population explosion." Issues faced by programs at that time are discussed. Over time, programs generally have moved to a simpler "service" approach. As increasing numbers of countries reach replacement-level fertility, and as policies are formed against the background of the 1994 International Conference on Population and Development held in Cairo, the role of family planning programs is increasingly debated and questioned. This article examines the responses of Asian countries and the population challenges that remain.

Asia↗
PubMedDate not supplied

Joint working with hospice teams: a renal collaborative approach.

There are over 600 million people in the world aged 60 years and over. This figure is expected to double by 2025 and to reach 2 billion by 2050 (1). Population ageing is characteristically accompanied by an increase in the burden of chronic non-communicable diseases such as diabetes, cardiovascular disease, cancers and renal failure. As a consequence, pressures on health systems worldwide will increase (1). Data produced by the National Renal Workforce Planning Group in 2002 (2), predicted that the demand for renal replacement therapy (RRT) will continue to rise beyond 2010 for many reasons one of those being demographic changes with an aging population. This will also have an impact on the numbers of patients predicted to commence dialysis and transplantation (Table 1). With this higher projection of patients requiring RRT, there is a need to look at new ways of working.

Continuity of Patient Care↗
PubMed1970

Propulsion (mass movements) in the human colon and its relationship to meals and somatic activity.

Propulsive activity of the human colon was measured with radiopaque markers (shapes), radiotelemetering capsules, Perspex capsules containing (51)Cr, or with free (51)Cr sodium chromate. Propulsive activity can be readily detected by these techniques, none of which requires the use of radiological contrast media. With capsules containing (51)Cr or with free (51)Cr repeated observations can be made in the same patient without recourse to radiography. The patient can remain normally active during the test with encapsulated (51)Cr. Repeated observations may also be made with shapes, if films exposed at low mA are used. It was found that colonic intraluminal pressure activity rises markedly during and after food, but that in the resting patient this increase is rarely associated with propulsive activity. In physically active patients propulsion of colonic contents was significantly increased after meals. When colonic propulsion takes place, it does so by a series of mass movements. These results suggest that somatic activity is an important factor in the control of colonic transit in health or disease.

Adult↗