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PubMed2002

[A brief history of evidence-based medicine].

Evidence - based medicine, a fairly new subject, focusing on the perfect combination of individual clinical experience, existing best evidence available and patient value, has created a new approach and thought for clinicians and researchers. Evidence - based medicine has promoted the transition of health care. The definition and development of evidence - based medicine in China and the world as a whole are reviewed in this article.

China↗
PubMed2003

[Challenge testes for diagnosis and follow-up of children with food allergy].

BACKGROUND: The prevalence of food allergy increased worldwide in the last century. In Chile we became aware of this increase 10-15 years ago, after an epidemiological transition on health. AIM: To assess the most frequent clinical presentations of food allergy, results of circulating immunologlobulins (total IgE, specific IgE and IgG4 against cow's milk) and usefulness of a standardized challenge test. PATIENTS AND METHODS: Cross sectional assessment of 49 patients with cow's milk allergy (9 months-8 years of age), diagnosed at INTA, University of Chile between 1991-2001. RESULTS: All patients had cow's milk allergy and 37% of them were additionally intolerant to other allergens. Seventy eight percent had digestive symptoms and 84% had non digestive symptoms. The cause of consultation was a non-digestive manifestation in 16% of cases. At least one of the immunoglobulins (total IgE total, specific IgE or IgG4) was over the cut off point in 92% of patients. Between 1990-1995 six patients were diagnosed with cow's milk allergy and malabsorption syndrome. Suppression of the specific allergen resulted in disappearance of symptoms in 78% of patients; when a second dietary modification was necessary 87% of cases showed a good response. Thirty five of 56 challenge tests performed were done at home, by relatives, in a non-controlled fashion. All of them were aimed to determine the desensitization of the child. CONCLUSIONS: Digestive and non-digestive manifestations were observed in these patients with food allergy. Although not designed to assess laboratory tests, results show that serum immunoglobulin determinations were helpful in guiding diagnosis. Mothers and relatives should be educated to accept diagnostic challenges and avoid carrying out non-controlled challenges.

Allergens↗
PubMedDate not supplied

Special medical concerns in the dental management of older adults.

By the year 2040, older adults will account for approximately 21% of the population of the United States, a significant increase from 1900 (4%) and 1990 (12%). The most rapidly growing segment of the United States population is people aged 85 and older. Currently, 85% of individuals over 65 have one or more chronic illnesses, while 30% have three or more. These individuals and their illnesses account for more than 33% of this country's health care costs.

Aged↗
PubMedDate not supplied

The impact of falling rates of edentulism.

PURPOSE: The aim of this study was to investigate the impact of both population age changes and falling edentulism rate on the denture market in three European countries. MATERIALS AND METHODS: Detailed information on the rate of edentulism for only three European countries (Finland, Sweden, and the UK) was available. For the UK and Sweden, published predicted rates of edentulism for the future decades were used, whereas predictions for Finland were computed using published edentulism rates. Edentulousness in one jaw was also predicted and included in the computation. Demographic projections were taken from government agency websites. RESULTS: The denture market will decrease in the three countries. Sweden, where edentulism is already low, will experience the largest percentage decrease (60%) over 20 years, but, in absolute number, the change will be of smaller magnitude than that in the UK and Finland. The range of projections for Finland was large, reflecting the difficulty of predicting trends with incomplete information. Within the limitations of this study's design, the impact of population age changes will not increase the denture market in Europe, even with the most pessimistic projections for edentulism rate. CONCLUSION: The complete denture market in Europe will fall despite changing age demographics. The falling rates are large enough to markedly affect future patterns of treatment provision and training.

Aged↗
PubMed2004

Reappraising prosthodontic treatment goals for older, partially dentate people: Part II. Case for a sustainable dentition?

The second of this two-part series, on the theme of estimating prosthodontic treatment needs and goals for older, partially dentate people, examines the roles of patient-perceived functional impairment, treatment outcome and changing demographic profiles in influencing these goals. In contradistinction with the lack of compelling evidence for the basis of the traditional, morphologically-driven prosthodontic treatment strategy, the evidence that the assessment of treatment need should take greater account of individuals' felt oral functional concerns, and thereby assuming a more problem-oriented, outcomes-based approach to prosthodontic decision-making, is gaining strength. Furthermore, the current blueprint guiding prosthodontic planning and procedures cannot be exempt from the far-reaching changes in society brought about by new economic and social realities, and will need to transform itself in the light of new evidence. How these realities translate in a developing country context is not certain, but it is known that inequalities in access to, and the provision of healthcare are related to socio-economic factors, be they prevailing or of residual nature from past structural conditions. Such conditions adversely affect peoples' health status and add urgency to the pursuit of viable and appropriate management strategies. In the context of a reappraisal of current prosthodontic paradigms, the shortened dental arch concept is presented as a potentially compelling strategy for the appropriate management of the ageing, partially dentate patients in South Africa, whose access to healthcare is inequitable. Since dental and oral health status is variable, the management strategy highlighted here should be seen as one, albeit an important one, within a range of available options.

Adaptation, Physiological↗
PubMed2004

Enhancing cultural competencies of advanced practice nurses: health care challenges in the twenty-first century.

Shifting population demographics will have a major impact on the practice of advanced practice nurses (APNs). The ethnic composition of people in this country is becoming increasingly diverse. Massachusetts and, in particular, the city of Worcester is also experiencing changes in the diversity of its population. These trends testify to the great need for APNs who are sensitive to and competent to care for culturally diverse populations. To address these changes, specific curricula enhancements focused on ethnically diverse populations were implemented for the nurse practitioner specialties at the Graduate School of Nursing (GSN), University of Massachusetts Worcester. The processes used for this project included visiting community and clinical sites, identifying key curricular components, and evaluating existing didactic and clinical learning experiences. The GSN faculty developed a systematic plan for integrating these components into the graduate nursing core, advanced practice core, and specialty courses of the respective curricula. A major outcome of this project was the enhanced preparation of APN students to meet the multifaceted needs of ethnically diverse patients, families, and communities.

Attitude of Health Personnel↗