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PubMed2005

[The specific features of the detection, clinical manifestations, and treatment of tuberculosis in the HIV-infected].

The present study has explored the specific features of the detection, clinical manifestations, and treatment of tuberculosis (TB) in 425 patients with TB and HIV infection. According to the time of joining the infections, the patients with TB and HIV infection are divided into 2 basic groups: 1) HIV infection is primary, TB develops at any stage of HIV infection and 2) TB is primary, HIV injections joins different forms of TB at its any stage. The social makeup of patients with TB/HIV infection is unfavorable: the unemployed, 50%; homeless persons, 26.5%; employees, 5%; workers, 9%; pensioners, 1.5%; the disabled, 5%; pupils, 3%. As compared with Group 2, Group 1 shows more employees and pupils and fewer homeless persons, which is associated with the younger age of patients in this group and their greater social security. In the pattern of clinical forms of tuberculosis in Group 1, there are prevalent forms of primary tuberculosis with lesion of intrathoracic and peripheral lymph nodes (12.8%), acutely progressive disseminated and miliary tuberculosis of the lung and extrapulmonary systems and organs (49%), among them, meningitis accounts for 4%, lesions of the liver, spleen, kidney, and other organs form 17%. In patients with tuberculosis and HIV infection, bacterial isolation has been established in 58% of cases; primary and multidrug resistances have been found in 53 and 8.9%, respectively. Multidrug resistance tends to increase: 2% in 2001, 3.4% in 2002, 4.6% in 2003, and 8.9% in 2004. Bacteria have been more frequently isolated in Group 2 than in Group 1 (81% vs 19%), which is accounted for by the magnitude of destructive changes in them in the presence of infiltrative TB and by the high incidence of fibrocavernous tuberculosis. The patients with TB/HIV infection have a concomitance of 3 infectious diseases: HIV infection, TB, and, in 74% of the patients, sexually transmitted infections (syphilis, chlamydiosis, gonorrhea) that, in accordance with Resolution No. 188 passed by the Government on April 2, 2003, are in the list of infectious diseases constitute a serious hazard to other people. The proportion of TB/HIV patients with drug abuse (65%), hepatitis B and C (47%), and nervous and mental diseases is extremely high, which makes these patients more hazardous to the healthy population. The efficiency of treatment for TB and HIV infection is satisfactory. Continuous therapy for 4 months or more provides positive clinical and X-ray changes in most patients; bacterial isolation ceases in 75%, and decay cavities close in 44% of cases. Abacillation and cavity closures have been observed in 76.3 and 38% and 47 and 14% of cases in Groups 1 and 2, respectively. Six-eight-month therapy with first-line drugs in combination with reserve ones in patients with pulmonary TB and HIV infection is well tolerated and highly effective. A decision on the duration of anti-TB treatment for the HIV infected should be taken into account the program resources and the probability of refusing long-term therapy in 50% of cases. Mortality rates in patients with TB and HIV infection are gradually on the rise and equal to 11.2% of the treated patients in 2001, 5% in 2002, 15.2% in 2003, and 19.6% in 2004. In patients with HIV/TB, the rates are higher than those in patients with TB/HIV and are 19.2 and 14.5%, respectively. Acutely progressive pulmonary TB and miliary TB of the lung and extrapulmonary organs and systems are a cause of death in most (76%) patients with TB/HIV.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

The seroepidemiology of hepatitis A and B in a Japanese town.

Sera collected from 1,118 healthy children and adults aged between four years and 90 years during the period 1989 to 1990, were tested for serological markers of hepatitis A virus (HAV) [antibody to HAV (anti-HAV)] and hepatitis B virus (HBV) [hepatitis B surface antigen (HBsAg) and antibody to hepatitis B surface antigen (anti-HBsAb)]. The overall prevalence rates of anti-HAV, HBsAg, and anti-HBV were 20.2%, 0.36%, and 5.1%, respectively. No body was found to be positive for anti-HAV below 30 years of age but more than 70% of the adults aged 50 years or over were positive for anti-HAV. The level of exposure of HAV infection is declining in Japan and paradoxically at the same time a vast majority of people are becoming susceptible to more severe illness. The fall in prevalence of HBsAg possibly represents the positive impact of ongoing vaccination programs and other preventive measures against HBV.

Adolescent↗
PubMed2006

Choosing indicators to evaluate Healthy Cities projects: a political task?

Ever since their beginning in 1986, Healthy Cities projects all over the world have been confronted with the issue of evaluation. However, after 20 years, many key dilemmas constantly reappear, people often looking for a kind of 'magic' list of universally applicable indicators to evaluate these initiatives. In this article we address five questions, allowing to illustrate the evaluative dilemmas the Healthy Communities movement is confronted with: Why evaluate Healthy Cities? What should be evaluated? Evaluate for who? Who should undertake the evaluation? How should the evaluation be performed? We conclude by formulating three recommendations in order to stimulate exchanges and debate. Our argument is based on a recent thorough analysis of the evaluative literature pertaining to the Healthy Cities movement, as well as on two decades of reflection on and involvement with this issue locally, nationally and internationally.

Cities↗
PubMed2002

Overview of cancer control programs in Japan.

Japan has a population of about 127 million, with an average life expectancy that is one of the highest in the world. Cancer has been the leading cause of death in Japan since 1981. The incidence of cancer for all sites in 1994 was estimated to be 440 000; crude incidence rates per 100 000 for males and females were 416.3 and 299.4, respectively. In 1997, the number of cancer deaths was 275 413; crude death rates for males and females per 100 000 were 273.0 and 169.9, respectively. Projections for 2015 indicate that 890 000 people will develop cancer and 450 000 will die as a result. It is not too much to say that Japan is now amid a 'Cancer Era'. Meanwhile, the progress in medical sciences is improving survival in cancer patients; in cancer patients diagnosed during 1987-89, relative 5-year survival was reported to be 41.2% for all sites and cancer survivorship research estimated the number of cancer survivors for all sites in 1998 who have lived for between 5 and 24 years after diagnosis to be 1.5 million. The Ministry of Health and Welfare is focusing on five different measures in the implementation of its cancer control programs: public health education, nationwide cancer screening programs, development and support of specialized medical institutions, training of specialists and promotion of basic and clinical cancer research. As a tool for public health education, the Ministry published in 2000 a 10-year health promotion program entitled 'Healthy Japanese in the 21st Century'. In the plan, seven particular goals are enumerated with regard to cancer. In practice, issues of concern include the development of new modalities, telling the truth to cancer patients, clinical trials and bioethical issues.

Female↗
PubMedDate not supplied

[To the 20th anniversary of the Chornobyl accident study of vitamin status and provision with micro- and macroelements of limited groups of people at different time periods since the accident at Chornobyl nuclear power plant].

Results of the study of the provision with vitamins and some micro- and macroelements of limited groups of people, who suffered from the accident at the Chornobyl nuclear power plant (ChNPP), which have been carried out by Ukrainian and Russian scientists during various periods after the accident, are generalized in the paper. Persons which participated in liquidation of the accident and lived during the accident in the territory, adjoining to Pripyat (the Kyiv region, town of Slavutich), people which worked at the object "Shelter" and ChNPP were involved in the inspection. It was noted, that in 1-4 years after the ChNPP accident in blood of liquidators the biochemical parameters displaying security of their organism by vitamins A and B1, remain lower in comparison with the same parameters in a group of relatively healthy persons which were not affected by the accident (control), that testifies to stable metabolic disturbance in the organism of people under irradiation influence. Selective inspection of the vitamin status of ChNPP and object "Shelter" personnel in 1992 has shown, that provision with vitamins C, B1, B2, B6 of the overwhelming majority of these people (67-91%) are much below the norm. Deficiency of vitamins C, B1, B6, folate and selenium is also revealed in an organism of 50-90% of women and children living in Slavutich. Deficit of vitamins in most of persons was characterized by polyhypovitaminoses, that is a combination of several group B vitamins deficiency at simultaneously low provision with selenium, and in a part of women and children--by low amount of iron. The results of long-term complex studies by groups of authors give evidence on importance and urgency of formulation and execution of International program on optimisation of nutrition, micronutrition status and health among population of affected areas in Ukraine, Bielorus' and Russia.

Calcium↗
PubMed1980

Influence of ecologic events on cafeteria food selections: understanding food habits.

Our data confirm that, in terms of eating, people are creatures of habit. Most food selections in an employee cafeteria showed remarkable stability across time, appearing relatively immune to such naturalistic changes as seasons, outdoor temperature, and day of the week. A rew seasonal variations were observed, but these resulted largely from changes in food availability. A tendency for lower calorie food selection was observed during late spring and the summer months. This finding should caution researchers, when evaluating any public health intervention program designed to reduce caloric consumption which is conducted during the spring-summer time period. An inventory control cash register system provides a promising methodology for conducting public health field experiments on food selection. Daily information on food purchases allows food selections of large population groups to be intensively scrutinized. This methodology can be readily applied to improve our understanding of the process of food selection in public and to evaluate ways of promoting healthy eating habits.

Animals↗
PubMed2001

A public health framework for addressing black and white disparities in preterm delivery.

The Healthy People 2010 objectives call for the elimination of racial disparities in health, along with reductions in several multifactorial perinatal outcomes. Evidence-based interventions have been the focus of discussion to date. We propose a 6-component framework based on knowledge from the social, medical, psychological, and epidemiological literatures to guide development of interventions to reduce preterm delivery and eliminate disparities. Pilot testing and rigorous evaluation of the interventions developed from this framework are encouraged.

Black or African American↗
PubMed2006

Prostate cancer incidence and intake of fruits, vegetables and related micronutrients: the multiethnic cohort study* (United States).

OBJECTIVE: To describe the relationship between the intake of fruits, vegetables, and related vitamins and antioxidants, and the risk of prostate cancer in male participants in a large multiethnic cohort study. METHODS: Food and nutrient intakes in 1993-1996 were calculated from a detailed food frequency questionnaire (FFQ) designed to account for the food and nutrient intake of the ethnic groups represented in the study (82,486 African-American, Japanese-American, Native-Hawaiian, Latino and White males included here). Follow-up for incident cancers utilized local SEER registries. Vital status was ascertained using state death files. Data on PSA utilization from a later questionnaire was also examined. RESULTS: A total of 3,922 incident cancer cases were ascertained during follow-up. Modestly increased risks of prostate cancer were observed in relation to higher intakes of several food items including light green lettuce and dark leafy green vegetables. Notably, no significant protective associations of any foods were seen, including tomato intake; and intakes of two complex foods containing tomato sauce (pizza and Spanish rice) were associated with modest increases in risk. PSA test use was significantly and positively related to intake of some of these same items, implying a degree of disease detection-bias. Analysis of non-localized and high grade disease (1,345 cases) showed no significant protective associations with overall fruits and vegetables intake, related micronutrients, or with intake of selected complex food items. CONCLUSIONS: We found no statistically significant evidence of a protective effect against prostate cancer of higher levels of intake of any of these foods, associated micronutrients or supplements. A possible explanation for the positive associations with risk of several of the foods normally considered to be healthy is detection bias, since "healthy" dietary intake was related to greater use of the PSA test.

Black or African American↗
PubMed1984

Follow-up study of the arrhythmic graduates from the schools under the heart disease program for students in Osaka.

A long term follow-up study of arrhythmic graduates from junior or senior high schools under the Heart Disease Program in Osaka was performed by mailing questionnaires. The age of the total 515 subjects ranged from 20 to 38 years, 26.9 years on an average. From 397 graduates (77%), answers to questionnaires were obtained. We could confirm 92 graduates were alive (18% of total subjects) among the 118 graduates who did not return their answers to the questionnaires. The following is what we could confirm through the present study: The prognoses of simple premature beats, Wenckebach type heart block and complete right bundle branch block are good in young adults. The prognosis of sick sinus syndrome does not warrant an optimistic prognosis even in young adults. The prognosis of WPW syndrome in young adults is not always fair if they have a history of paroxysmal tachycardia. From 95 to 97% of the graduates with arrhythmia as a whole answered that their daily lives are quite similar to those of healthy people. Attitudes toward daily life and medical checks were also studied.

Activities of Daily Living↗
PubMed1999

Status of the year 2000 health goals for physical activity and fitness.

In Healthy People 2000, the national strategy for improving the health of the American people by the year 2000, lifestyle factors such as physical inactivity are major determinants of chronic disease and disability. Despite the documented benefits of exercise in enhancing health and reducing the risk of premature death, only 1 of the 13 physical activity and fitness objectives of Healthy People 2000 has been met or exceeded. Although progress toward 5 objectives for the year 2000 has been made, 3 objectives are actually farther from attainment. Coronary heart disease death rates (Objective 1.1) have declined, and the prevalence of overweight people (Objective 1.2) has increased. Overall physical activity in adults (Objectives 1.3 and 1.4) and strengthening and stretching activities in children (Objective 1.6) have increased, but reduction in the percentage of sedentary persons (Objective 1.5) has showed no change. The proportion of the population adopting sound dietary practices combined with regular physical activity to attain appropriate body weight (Objective 1.7) has declined. Even though participation in daily school physical education (Objective 1.8) has shown a decline during the past several years, students who are enrolled in physical education classes are spending more time performing physical activities (Objective 1.9). The proportion of work sites offering employer-sponsored physical activity and fitness programs (Objective 1.10) has increased substantially, surpassing the year 2000 goal. Data to update progress for increasing physical activity levels of children (Objectives 1.3-1.5), community exercise facilities (Objective 1.11), clinician counseling about physical activity (Objective 1.12), and improvement in personal self-care activities (Objective 1.13) are not yet available.

Adolescent↗
PubMed2004

Implementation of the Australian core public health functions in rural Western Australia.

OBJECTIVE: To assess the implementation of the Australian core functions of public health in rural Western Australia. METHODS: Cross-sectional surveys (n=26) and semi-structured key informant interviews (n=64) with public health practitioners throughout each of the eight rural health regions in Western Australia. A scoring system was utilised to categorise responses that were frequently part of current practice (score=2), sometimes undertaken (score=1) and rare or not undertaken at all (score=0). RESULTS: Functions with reasonably good coverage (mean score 1.0) included: preventing and controlling communicable and non-communicable diseases; promoting and supporting healthy lifestyles; planning, funding, managing and evaluating health gain; ensuring safe and healthy environments; and contributing to healthy growth and development through all life stages. Lower levels of coverage were found for: assessing health needs; developing healthy public policy and fiscal measures; strengthening communities; and improving health for Aboriginal people and other vulnerable groups. CONCLUSIONS: There are limitations in the capacity of the rural public health workforce in Western Australia to implement the core public health functions. While some areas were defined as being adequately addressed, gaps in implementation appeared across all nine functions. IMPLICATIONS: The Australian core functions can be utilised to broadly assess current public health practice, however further development of the functions and their measurement, plus methods to align accountability measures for current public health practice with the core functions, are required.

Cross-Sectional Studies↗
PubMed2000

Georgia's breastfeeding promotion program for low-income women.

OBJECTIVE: Beginning in 1990, Georgia's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) initiated 5 new strategies to promote breastfeeding among its pregnant and postpartum clients. These strategies were implemented in 1991, each to be provided as an addition to its standard program of counseling on breastfeeding and distributing appropriate literature: 1) enhanced breastfeeding education, 2) breast pump loans, 3) hospital-based programs, 4) peer counseling, and 5) community coalitions. The enhanced breastfeeding education strategy provides access to a hotline as well as periodic training of staff, and the breast pump loan provides free breast pumps to mothers who want to use them. The hospital-based strategy provides bedside support and counseling to women who have just given birth and includes staff training, as well as a hotline number for women to call after they leave the hospital. The peer-counseling strategy focuses on identifying former WIC participants who have successfully breastfed their infants; these women are recruited to provide support and encouragement to current WIC participants. Finally, the community coalitions approach is designed to identify existing community attitudes about breastfeeding, establish plans to address gaps in breastfeeding services, to develop resource guides on breastfeeding for the community, and to advocate at the community level to support breastfeeding women. The objective of our research was to evaluate the impact of breastfeeding promotion strategies on breastfeeding initiation among WIC participants in Georgia. METHODS: Using data from the Pregnancy Nutrition Surveillance System (PNSS) for 1992-1996, we examined breastfeeding initiation rate during this period and compared rates among 6 different intervention strategies. Also, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to assess breastfeeding initiation and duration among WIC enrollees. We conducted 13 focus groups to understand the experiences of program participants. Ten focus groups were conducted with women who were breastfeeding their infants, 3 each with women from the community coalitions, hospital-based programs, and standard education programs, and 1 with women from the breast pump loan program. Three focus groups were conducted with women who were feeding their infants formula. RESULTS: PNSS data show that breastfeeding initiation increased in the Georgia WIC program from 31.6% in 1992 to 39.5% in 1996. PRAMS data confirmed the increase in breastfeeding initiation from 33.6% (standard error [SE]: 2.2) in 1993 to 42.1% (SE: 2.4) in 1996 among WIC participants. Both datasets (PRAMS and PNSS) showed breastfeeding initiation to be well below the year 2000 goal of 75%. Overall, PRAMS data show a high breastfeeding initiation among non-WIC participants (range: 64.7% [SE: 2.2]) for 1994 to 70.1% (SE: 2.2) in 1996. The percent change between 1993 and 1996 was 8% for non-WIC participants, and it was 25% for the WIC participants among those responding to the PRAMS questionnaire. Data from PRAMS indicated no statistical change in the percentage of WIC enrollees who breastfed their infants for 8 weeks or more; this estimate was 18.3% (95% confidence interval (CI): 14.9-21.8) in 1993 and 19.4% (95% CI: 15.7-23.2) in 1996, well below the Healthy People 2000 objective of 50% at 6 months. According to PNSS data, the largest increases in breastfeeding initiation for 1992 to 1996 were among younger women (</=19 and 20-24 years old), those with no college (less than high school and high school only), unmarried, and black women (see Table 1). The smallest increases during this period were among older women (30+), those with more than a high school education, and women who were white, Hispanic, or from other ethnic or racial groups. The PRAMS data (1993-1996) generally display similar results, but the pattern by marital status demonstrated larger increases for married women than for unmarried women.

Breast Feeding↗
PubMed2005

A prospective study on the prevalence of metabolic syndrome among healthy french families: two cardiovascular risk factors (HDL cholesterol and tumor necrosis factor-alpha) are revealed in the offspring of parents with metabolic syndrome.

OBJECTIVE: The purpose of this study was to estimate the longitudinal variation of prevalence of metabolic syndrome within French families and to observe biological parameters involved in cardiovascular disease among their offspring. RESEARCH DESIGN AND METHODS: Three hundred seventy-one apparently healthy families (1,366 individuals) taken from the STANISLAS cohort were studied. The subjects were examined at two time points with a 5-year interval (t(0) and t(+5)). The crude prevalence of metabolic syndrome was assessed among parents according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP) definition. RESULTS: The prevalence of metabolic syndrome was 5.9% in men and 2.1% in women at t(0), rising to 7.2 and 5.4% in men and women, respectively, at t(+5). Children of parents having metabolic syndrome showed higher levels of tumor necrosis factor-alpha (TNF-alpha), whereas their HDL cholesterol and apolipoprotein (apo) E concentrations were lower compared with those of age- and sex-matched control subjects (P </= 0.05). When applying NCEP ATP definitions that included either antihypertensive drugs only or all the drugs involved in metabolic syndrome, we found that the three parameters shared by the three different versions of the definition were TNF-alpha, HDL cholesterol, and an interaction between alcohol consumption and parental metabolic syndrome on HDL cholesterol concentration. CONCLUSIONS: Metabolic syndrome increases with age in supposedly healthy families from the STANISLAS cohort. In offspring of affected people, it seems to be predictive of higher values of TNF-alpha and low HDL cholesterol levels, which are two major cardiovascular factors. Therefore, in terms of prevention, it is important to identify and follow subjects with metabolic syndrome as well as their offspring, even in apparently healthy populations, to enable early disease management.

Adolescent↗
PubMed1994

[History of the development and functional description of the Nucleus cochlear implant].

For deaf children and adults who derive no significant benefit from conventional hearing aids the cochlear implant (CI) has become a clinically accepted alternative. More than 7,000 people worldwide, including over 2,000 children, have received the 22 channel Nucleus Mini System during the last decade. The functional principle of the CI is the translation of acoustic sound signals into electrical impulses for direct stimulation of the hearing nerve. The middle ear and the damaged sensory organ of the inner ear are completely bypassed. The function of the healthy ear is replaced by a microphone, an electronic speech processor, and stimulation electrodes. Approximately two thirds of the postlingually deafened CI users achieve open set speech understanding without lipreading through the Nucleus implant. The Nucleus system is a programmable digital device and is continuously being improved in terms of both performance and ease of use. It is the only CI system with FDA approval for use in both adults and children from 2 years of age. Over 100 European clinics in more than 20 countries are carrying out successful CI programs with the Nucleus device in compliance with strict pre- and postsurgical diagnostic and rehabilitative guidelines. In Austria it was introduced to the Landeskrankenanstalten Salzburg in 1992. A successful program, including specialized rehabilitation, is carried on in close cooperation with the world's largest Cochlear Implant Center in Hannover, Germany.

Adult↗
PubMed2000

Increasing pneumococcal vaccination rates among residents of long-term--care facilities: provider-based improvement strategies implemented by peer-review organizations in four western states.

OBJECTIVE: To evaluate collaborative efforts and intervention strategies by peer-review organizations (PROs) and long-term-care facilities (LTCFs) for improving pneumococcal vaccination rates among residents of LTCFs. DESIGN: Prospective, before-after quality improvement project. SETTING: 133 LTCFs in Alaska, Idaho, Montana, and Wyoming. PATIENTS: All residents of participating LTCFs. METHODS: Baseline pneumococcal vaccination rates were determined by medical-record review, self-reporting by patient or family members, and review of Medicare claims information. Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF. RESULTS: 133 LTCFs with 7,623 residents from Alaska, Idaho, Montana, and Wyoming participated in this quality-improvement project. This accounted for 41% (133/321) of the potential nursing homes and resident population in the participating states. Baseline overall vaccination rates were 40% (3,050/7,589). The overall vaccination rate improved to 75% (5,720/7,623, P<.001). The number of facilities meeting the Healthy People 2000 vaccination goal of 80% improved from 18% (24/133) to 62% (83/133, P<.001). Initial use of chart stickers and implementation of standing orders led to similar increases in vaccination rates, but the standing-order strategy required commitment of fewer PRO resources at a statewide level. Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70% in facilities enforcing a standing-order policy. CONCLUSIONS: Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates. Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives. Standing orders appear to be one intervention effective in sustaining successful vaccination efforts. Regardless of the specific interventions employed, PROs played a significant role in facilitating vaccination program development and intervention implementation.

Aged↗
PubMed1999

Lifestyle modifications to prevent and control hypertension. 3. Recommendations on alcohol consumption. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of alcohol consumption on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: There are 2 main options for those at risk for hypertension: avert the condition by limiting alcohol consumption or by using other nonpharmacologic methods, or maintain or increase the risk of hypertension by making no change in alcohol consumption. The options for those who already have hypertension include decreasing alcohol consumption or using another nonpharmacologic method to reduce hypertension; commencing, continuing or intensifying antihypertensive medication; or taking no action and remaining at increased risk of cardiovascular disease. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1996 with the terms ethyl alcohol and hypertension. Other relevant evidence was obtained from the reference lists of articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design, and graded according to the level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: A reduction in alcohol consumption from more than 2 standard drinks per day reduces the blood pressure of both hypertensive and normotensive people. The lowest overall mortality rates in observational studies were associated with drinking habits that were within these guidelines. Side effects and costs were not measured in any of the studies. RECOMMENDATIONS: (1) It is recommended that health care professionals determine how much alcohol their patients consume. (2) To reduce blood pressure in the population at large, it is recommended that alcohol consumption be in accordance with Canadian low-risk drinking guidelines (i.e., healthy adults who choose to drink should limit alcohol consumption to 2 or fewer standard drinks per day, with consumption not exceeding 14 standard drinks per week for men and 9 standard drinks per week for women). (3) Hypertensive patients should also be advised to limit alcohol consumption to the levels set out in the Canadian low-risk drinking guidelines. VALIDATION: These recommendations are similar to those of the World Hypertension League, the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension and the previous recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control and the Canadian Hypertension Society. They have not been clinically tested. The low-risk drinking guidelines are those of the Addiction Research Foundation of Ontario and the Canadian Centre on Substance Abuse. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. The low-risk drinking guidelines have been endorsed by the College of Family Physicians of Canada and several provincial organizations.

Adult↗
PubMed2000

Clinical practice: new challenges for the advanced practice nurse.

This report describes the challenges for advanced practice nurses (APNs) relative to supply and demand issues. The article also includes opportunities with the Balanced Budget Act, physician acceptance of Advanced Practice Nurses, and expanding practice opportunities. The challenges include the nursing shortage (both in nursing students and faculty), the aging of the nursing workforce, and a lag in nursing salaries; increased demand for nursing based on aging baby boomers, increasing patient acuity and technology, and new arenas for practice. The Balanced Budget Act of 1997 provided new opportunities for advanced practice nurses, including enhanced autonomy to provide services and bill independently of physicians. With these changes come new opportunities for advanced practice nurse entrepreneurs in the areas of independent practice, including opportunities to positively impact the health of families and communities in alignment with the Federal government's vision for "Healthy People 2010." As physician acceptance of advanced practice nurses continues to grow and in light of the changes in medical practice and education (residency reduction), opportunities to expand collaborative practice arrangements also exist. APNs are best suited to make the most of these changes. One example of an opportunity for independent practice, a Community Wellness Center, is developed as an entrepreneurial venture benefiting both the APN and the health of a community. Who better than registered nurses (RNs), especially those practicing at the advanced level, can ensure that these opportunities and challenges are addressed in an ethical manner and focused on the needs and health of the community?

Government Programs↗
PubMed1991

A biochemical investigation on chicken gout observed in the Marmara region in Turkey.

Poultry breeding has economical importance for the people living in Bursa and surrounding villages. Similar to some sporadic disease, gout can also be reason for production loses and death in laying and broiler chickens. Gout cases have been observed in some pens of a big poultry company. In this study 20 healthy control and 40 sick Studler Iso-Brown chickens were used as research materials. Blood were taken from heart by syringe to plastic tubes with EDTA. Plasma were collected and analyzed for total protein, uric acid, bicarbonate, vitamin A, calcium and orotic acid. The blood levels of healthy and sick groups were; total protein % 4.60-5.98 gr, uric acid % 10.19-38.09 mg, bicarbonate 27.37-35.73 mEq/l, vitamin A % 42.20-35.55 mcg, calcium % 8.38-8.25 mg and orotic acid % 1.42-1.97 mg, respectively. Statistical analysis was done by t test. There were statistical importance for total protein, bicarbonate (p less than 0.01) and for uric acid (p less than 0.001) differences. Feeding program analysis was done and a feeding disturbance was determined. Chicken in gout observed pens have fed with chicken developing feed for two weeks earlier. For this case diet was the reason of gout.

Animals↗