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PubMed2002

Implementing regional information system for social and health care in Finland, Satakunta.

The Regional Information System, RIS is based on the open, regional architecture and it supports the regional, client-oriented seamless services in social and health care. By using the RIS it is possible for professionals for example to get an overview of the client's situation and to make a service chain plan for the client with the client's consent. The client can get access to his/her own data and to see his/her service plan, consents and log file. The development of the RIS started in the area of Satakunta in January 1999 and the implementation started in November 2001 in a national Macro Pilot project. The Ministry of Social Affairs and Health prepared a special law for Satakunta to enable the handling of client data in a regional context and the developing a regional system. The Ministry selected in the Spring 2001 three regions more in Finland to develop their services within the experimental Act. These four regions are approximately 50% out of the population in Finland.

Computer Security↗
PubMed1990

[The Göttingen Risk, Incidence and Prevalence (GRIPS) study. Recommendations for the prevention of coronary heart disease].

The Göttingen Risk-, Incidence- and Prevalence Study (abbreviated GRIPS) consists of several epidemiological projects, among which project B is currently the most important one. Project B is a prospective cohort study, which was started in 1982 by a baseline investigation, including approximately 6000 men aged 40 to 60 years. Follow-up investigations were performed in 1985 and 1987 in order to record reasons of death and incidences of newly developed diseases. Further follow-up investigations are planned for 1990 and 1992. Until now incidence data of death and diseases are available for a 5-year observation period (January 1982-December 1986), and for more than 95% of the original study participants. The results clearly indicate that plasma levels of LDL-cholesterol, followed by plasma concentrations of total cholesterol and apoprotein B are the predominant predictors for the risk of coronary artery diseases (CAD; i.e. fatal and non fatal myocardial infarction as well as sudden coronary death and chronic coronary heart disease). Further significantly positive associations to the incidence of myocardial infarction (MI) were found for the following parameters: Systolic and diastolic blood pressure, family history of premature MI, cigarette smoking, plasma levels of triglycerides, VLDL-cholesterol and blood glucose. Plasma concentrations of HDL-cholesterol and apo A1 showed an inverse relationship to the MI incidence and--somewhat weaker--the same was true for the frequency of alcohol consumption and of physical leisure activity. Besides LDL-cholesterol, total cholesterol and apoprotein B the following parameters showed significantly positive associations to the risk of chronic coronary heart disease: Systolic as well as diastolic blood pressure and--to a lesser extent--the plasma levels of triglycerides, VLDL-cholesterol and blood glucose. An inverse relationship to the incidence rate of chronic coronary heart disease was found for HDL-cholesterol, apo A1 and the frequency of physical leisure activity. Based on the epidemiological results from GRIPS, additionally considering results from other epidemiologic studies and pathophysiological findings a diagnostic strategy was developed for the early recognition of patients at increased coronary risk. LDL-cholesterol is the most important variable in this diagnostic schedule but the coronary status and the individual profile of further risk factors (i.e. positive family history of premature myocardial infarction, hypertension, diabetes mellitus, cigarette smoking, increased plasma levels of triglyceride rich lipoproteins or Lp(a) as well as decreased plasma concentrations of HDL-cholesterol or apo A1) are additionally taken into account.

Adult↗
PubMed1988

[Treatment of prostatic cancer with slow-release formulation of luteinizing hormone releasing hormone (LH-RH) analog].

A slow-release formulation of the luteinizing hormone releasing hormone (LH-RH)analog(TAP-144-SR) was administered in 6 cases of prostatic cancer. Five were untreated cases, 3 of moderately-differentiated and 2 of poorly-differentiated cancers (four D2 and one C, NX), the other (D2) was under control by another LH-RH analog. The plasma level of luteinizing hormone and follicle stimulating hormone fell below normal, and the plasma testosterone was less than 1 ng/ml by four weeks after start of treatment. According to the National Prostatic Cancer Project Criteria, 2 of the untreated cases showed a partial response and 3 of the untreated ones showed a stable response, one of which underwent transurethral resection later. The pretreated case still continued controlled more than 4 months. No side effect was noticed.

Acid Phosphatase↗
PubMed1995

[Implementation and evaluation of quality circles in general practice].

In the beginning of 1993, society of panel doctors Südbaden, Germany, has constituted a group of experts from the Department of General Medicine of the university hospital and practising general practitioners (GPs) to develop an organisational and conceptional framework for setting up quality circles. At present, 23 quality circles with 6-12 participants are holding regular meetings every 4 to 8 weeks in the region of Südbaden. The group members, who are all physicians working in primary health care, are selecting and discussion topics which are important in general practice. In order to facilitate the discussions, the research group has developed predefined guidelines covering a wide range of common and important conditions in general practice (Hypertension, sleeping disorders, diabetes mellitus, COPD, dementia, lower back pain, cardio-vascular disease, depression, headache, vertigo etc). In presenting these structurized guidelines, the moderator prompts and encourage the group members to identify common problems in their own practices. The use of these guidelines in, quality circles and research may provide a starting point for developing consensus guidelines. The quality circle projects is given as systematic evaluation for both participants and moderators at different levels. Main objectives of the assessment are the recruitment, motivation and the specific goals of general practitioners to participate in quality circles. Currently, we are evaluating the development of quality circle for a period of 18 months.

Education, Medical, Continuing↗
PubMed1994

[Research in gene therapy--its status in Germany].

Progress in mammalian molecular biology and in the analysis of the human genome has allowed to identify the causes of an increasing number of human diseases in recent years. Newly developed gene transfer techniques were reason to implement new therapeutic concepts. By means of viral vectors or other transfer vehicles genes can be introduced into cells of the human body in order to replace a deficient function (in inherited diseases) or to play a role in defending the body (against cancer or, in the cardiovascular field, eventually by preventing restenosis). Despite considerable achievements of current DNA transfer technologies it seems premature to qualify gene therapy already as a new medical practice. The development in Germany is characterized by a late start in this field of research. The number of projects is correspondingly small. However, it may be expected that newly initiated governmental support of gene therapy research will lead to an expansion of the activities in this area.

Animals↗
PubMed1993

Principles, main goals and methods of the nationwide program: "investigations on iodine deficiency and model of iodine prophylaxis in Poland".

The main reasons to start investigations on IDD in Poland as a nationwide project of the Ministry of Health and Welfare sponsored by the State Committee For Scientific Research and Foundation for Polish Science were: cessation of iodizing of kitchen salt in Poland in 1980, increase of the incidence of goitre in the population and hyperthyrotropinemia in newborns, results of the survey undertaken after Chernobyl disaster indicating an increase of goiter incidence (Nauman et al.) and results of the pilot study (Gutekunst, Gembicki, Kinalska and Rybakowa) indicating an increase of thyroid volume and diminishing of iodine excretion in urine of children in Kraków, Białystok ad Poznań regions. Therefore the main goals of the project were as follows: to evaluate IDD in Poland on the population basis, to map goiter incidence and iodine deficiency in geographic areas, to evaluate a voluntary model of iodine prophylaxis in Poland (20 mg of KI/kg of salt). The investigations were carried out in 19330 children (48.7% of boys and 51.3% for girls) in age group 6-13 years, attending 111 coeducational randomly selected schools from all the country. This number represents 0.35% of children subpopulation in the above age-groups. For practical purposes local coordinating centers at the relevant Departments of Endocrinology and Board of Coordinators were set up. The programme of survey included: filling the questionnaire by children's parents, thyroid palpation and classification according to WHO and ICCIDD criteria, thyroid volume determination by means of ultrasonograph Kontron Sigma 1 L with linear transducer 7.5 MHz, determination of iodine in casual morning urine sample using Sandell and Kalthoff method. Determination of iodine concentration in urine was performed in each case of goiter and in the same number of children without goiter. The results were segregated according to coordinating centers and according to 6 geographical areas of the country. The results were calculated according to the descriptive statistics using Student's test, Chi-square test F-test and Leven's test. The results segregated according to geographic areas were tested by means of analysis of variance using the linear model. The final results of the programme are presented in the next papers.

Adolescent↗
PubMed1995

[The role of the basal ganglia in movement control].

It is now widely accepted that the basal ganglia (BG) are functionally organized with several segregated loops which start at a certain area in the cortex and project back to the same area in the cortex through the thalamus. The detailed functional organization of the BG motor loop has been described and used successfully to explain the mechanism of hypo- and hyper-kinetic disorders caused by BG disorders. Recent physiological and anatomical studies have provided new information concerning the function of these nuclei. The indirect pathway from the striatum to the external globus pallidus and then to the internal globus pallidus may be much more important than previous thought. The subthalamic nucleus may transmit excitatory input from the cortex as well as acting as a driving force on the globus pallidus. The role of BG output on the thalamus may not be to transfer information to the cortex via thalamocortical neurons, but rather to modulate the activity of cortico-thalamocortical loops. By varying it's discharge rate, the BG can change the membrane potentials of thalamocortical neurons which may result in focusing the activity of a specific cortico-thalamo-cortical loop and/or switching it to another.

Basal Ganglia↗
PubMed1996

New serotype candidate of Neisseria meningitidis.

In spite of a large collection of MAbs used for the whole-cell ELISA (WCE) in the National Reference Laboratory for Meningococcal Infections in Prague 50-80% of N.meningitidis strains isolated in the Czech Republic remained non-typable (NT) and/or non-subtypable (NST). A project focused on the problem of NT/NST N.meningitidis was started and the new serotype candidate designated "22" resulted from this research. This paper presents the method of preparing and testing of the monoclonal antibody (MAb) specific for this new serotype and the first experience acquired from using it. The new serotype-specific MAb is of IgG3 class, does not react with any serotype/subtype reference strains and reacts in WCE with the strain used for its production and with some other NT/NST strains in the dilution 1:1,000. A collection of 97 N.meningitidis B:NT strains isolated from cerebrospinal fluid and/or blood of patients with invasive disease in the Czech Republic since 1973 to 1995 was serotyped using the new serotype "22"-specific MAb and 37 of these strains (38.2%) gave positive WCE result. The total number of 59 N.meningitidis B:NT strains isolated in 1995 from various clinical situations were serotyped and 26 of them (44.1%) were positive with the new serotype "22"-specific MAb. Seven of these N.meningitidis B:NT strains isolated in 1995 from various clinical situations were serotyped and 26 of them (44.1%) were positive with the new serotype "22"-specific MAb. Seven of these N.meningitidis B: "22" strains were isolated from cerebrospinal fluid or blood of patients with invasive meningococcal disease and prevailed in the age group of 0-4 years (5 cases). The significance of the new serotype candidate was underlined recently, when this serotype "22" was recognized in N.meningitidis B strain isolated from a died 10 months old boy. These results indicate the epidemiological and clinical significance of the new serotype candidate "22" in the Czech Republic.

Animals↗
PubMed1997

Board development in two hospitals: lessons from a demonstration.

A recently concluded demonstration project examined efforts to improve the effectiveness of nonprofit boards. This article focuses on the interventions at two participating healthcare organizations and examines the outcomes of these efforts. Changes made at the Alpha Health Care system included: reduction in the number of boards, term limits established for board members, election of new board chairs for two of the fewer boards, reduction in the size of those boards, implementation of a consent agenda, and reorganization of the boards' committee structure. Fewer changes were implemented at the Beta Hospital, where several initiatives were started but only some of which were retained by the projects' conclusion. Key factors limiting the extent of changes there were the modest interest in an active board by a new CEO and the limited investment of trustees in change. The article concludes with a discussion of lessons learned about board assessment, the use of retreats to initiate board development, and the importance of time management and CEO support to strengthen board effectiveness.

Chief Executive Officers, Hospital↗
PubMed1990

A computer program for analyzing bivariate flow karyotypes.

This article describes a computer program for analyzing bivariate flow karyotypes of human chromosomes stained with Hoechst 33258 (HO) and chromomycin A3 (CA). The karyotype first is divided into regions that contain chromosome peaks. The chromosomes that are associated with those areas are identified. The distributions in these areas then are fitted with mathematical functions of increasing complexity. The process starts by fitting a specified number of univariate Gauss functions to projections of the HO and CA distributions of each area. The final fit can include multiple bivariate Gauss functions, including a background function for debris subtraction. The results of one stage in the fitting process serve as seed values for the next, more complex step. Since the program autonomously estimates the starting values for the iterative fitting procedures, the fit results are insensitive to operator bias and the program will consistently converge to the same solutions. The resulting table of parameter values can be used to compare flow karyotypes to a reference data set.

Chromomycin A3↗
PubMed1989

Projections of physician supply and demand: a summary of HRSA and AMA studies.

There is concern that the United States may have a surplus of physicians soon. In a continuation of a movement started around 1980 by the Graduate Medical Education National Advisory Committee (GMENAC) to quantify and project supply and demand for physicians, the American Medical Association (AMA) and the Health Resources and Services Administration (HRSA) have recently produced their latest studies on this subject. The HRSA conclusion, published in its 1988 report to the President and Congress on the status of health personnel in the United States, is that a surplus may come as early as 1990 and will probably worsen by the year 2000. The AMA study, also published in 1988, agrees with the HRSA and the GMENAC that supply will probably grow faster than demand, but it disclaims the notion of a surplus or shortage because that would imply judgments about the adequacy of current utilization rates by all segments of the population. The HRSA report cites a 1986 finding by the Robert Wood Johnson Foundation that access to medical care deteriorated between 1982 and 1986 for minorities and lower-income groups. On the supply side, the HRSA's estimates are somewhat higher than the AMA's, mainly because the former assumes faster growth in foreign medical graduates. Both studies use a demand-based approach to projecting the number of physicians required, but there are considerable differences in the assumptions made about future utilization rates.

American Medical Association↗
PubMed2001

A multicentre trial of recombinant growth hormone and low dose oestrogen in Turner syndrome: near final height analysis.

BACKGROUND: Turner syndrome accounts for 15-20% of childhood usage of growth hormone (GH) in the UK but final height benefit remains uncertain. The most effective strategy for oestrogen replacement is also unclear. METHODS: Fifty eight girls who, at start of treatment, were of mean age 9.1 years and projected final height 142.2 cm were randomised to receive in year 1, either low dose ethinyloestradiol 50-75 ng/kg/day, GH 28 IU/m(2) surface area/week as a daily injection, or a combination of ethinyloestradiol and GH. After the first year, the ethinyloestradiol treated girls received combination treatment. After two years, girls aged over 12 years were given escalating ethinyloestradiol to promote pubertal development. RESULTS: Near final height was available for 49 girls at age 16.5 years, 146.8 cm, representing a gain of 4.6 cm, range -7.9 to +11.7 cm. Twelve of the 49 girls gaining 7.5 cm or more were less than 13 years at the start and had received GH for at least four years. Height gain was correlated with greater initial height deficit. Fifteen girls (31%) reached 150 cm or more compared to a predicted 10%. Early supplementation with ethinyloestradiol provided no final height advantage. CONCLUSIONS: Final height gain was modest at 4.6 cm. Younger, shorter girls gained greatest height advantage from GH. Low dosage ethinyloestradiol before planned induction of puberty was not beneficial.

Adolescent↗
PubMed2000

1998-based national population projections for the United Kingdom and constituent countries.

The 1998-based national population projections, carried out by the Government Actuary in consultation with the Registrars General, show the population of the United Kingdom rising from 59.2 million in 1998 to over 63.5 million by 2021. Longer-term projections suggest the population will peak around 2036 and then gradually start to fall. The population will become gradually older with the median age expected to rise from 36.9 years in 1998 to nearly 42 years by 2021. In 1998, there were 1.4 million (13 per cent) more children aged under 16, than people of pensionable age. However, by 2008, the population of pensionable age is projected to exceed the number of children.

Adolescent↗
PubMed1998

Health consequences of Chernobyl and other radiation accidents. Report on the European Union Cluster Contractors' workshop (San Miniato, Italy, 17-22 June 1997).

The Radiation Protection Research Unit of the European Commission has been supporting collaborative research projects on the radiological consequences of the Chernobyl accident since 1991. However, in the Fourth Framework Programme of the Commission which started in 1996, the collaboration with scientists in the former Soviet Union has been placed on a different footing, and the programme has been expanded to include other regions, especially in Russia and Kazakhstan, where previous nuclear incidents have led to the exposure of workers and the local populations and to widespread radioactive contamination. There are 15 projects on health-related studies in the newly started programme, and in order to improve the collaboration between the different scientists working in these projects a Cluster Contractors' Meeting was organised in San Miniato, Italy, in June 1997 with the participation of some 50 scientists from the European Union (EU) and the Newly Independent States (NIS). This report summarizes the different topics, including molecular biology and treatment of childhood thyroid cancer, various epidemiological studies and dose reconstruction, which were discussed at the meeting and which form the major projects in the new collaborative programme.

Chromosome Aberrations↗
PubMed2000

Derivation of a two-generator framework of nonequilibrium thermodynamics for quantum systems

Starting from the quantum description of isolated systems on the microscopic level we derive the two-generator formulation of nonequilibrium thermodynamics by means of the projection-operator technique. As a generalized canonical ensemble is employed, we obtain a convenient starting point for practical calculations in nonequilibrium thermodynamics; in particular, also in the classical limit. All dynamical material properties are contained in a canonical nonequilibrium correlation. However, the generalized canonical approach is inappropriate for systems with large fluctuations; possible steps toward a suitable generalization for quantum systems are discussed.

Journal Article↗
PubMedDate not supplied

[The Mediterranean diet and cardiovascular disease: results of a pilot study from the SUN project (University of Navarre Follow-Up Study)].

BACKGROUND: The Mediterranean diet has been postulated as a model for the prevention of coronary heart disease. The SUN project ("Seguimiento Universidad de Navarra") is an epidemiological prospective cohort study of University of Navarre alumni started in 2000 with the main objective of identifying dietary and non-dietary determinants of these disorders. The feasibility of the project was verified in a two-phase pilot study. METHOD: Volunteers participated in the first phase of the pilot study. Dietary and non-dietary exposures were measured using self-administered questionnaires and interview. A random sample of 600 graduates was selected for the second phase of the pilot study. The selected alumni received a questionnaire by mail. The 10th, 25th, 50th, 75th and 90th percentiles were calculated for the consumption of each food item or nutrient to estimate the inter-subject variability. RESULTS: The participants understood and answered the questionnaires properly. The mean time spent in completing the questionnaire was 55 minutes (95% CI: 50.7-59.3). A wide inter-subject variability was found in the consumption of food items considered as more representative of the Mediterranean diet (olive oil, fruits, vegetables and wine) with major differences between the 10th and 90th percentile. A Mediterranean diet pattern was found with a wide inter-subject variability. CONCLUSIONS: The response rate was acceptable. This finding is likely to ensure the identification of associations between the consumption of given food items and the occurrence of the main outcomes we are targeting.

Adult↗
PubMed2003

Personal improvement project in nursing education: learning methods and tools for continuous quality improvement in nursing practice.

BACKGROUND: All health care providers, including nurses, need to learn how to improve the care they give. Continuous quality improvement (CQI) is a theory and method used in health care to guide improvement. The question is how best to teach it, particularly to nursing students. It was conjectured that a systematic approach to improve study habits and lifestyle would increase nursing students' awareness of how they handled their studies and, at the same time, became acquainted with improvement knowledge methodology. Using the starting point that 'quality is personal', students worked on personal change and improvement. The purpose was to learn methods and tools for improvement in their personal life and enable them to transfer and use this knowledge in their professional work. AIMS: To describe the use of a personal improvement project (PIP) by nursing students and the resulting increased knowledge, skills, and enthusiasm to continue working with CQI. METHODS: Forty-four nursing students worked on a PIP, which they felt was important, and presented their projects to fellow students. The students answered a questionnaire, and their presentations documented the results of their work. RESULTS: All 44 students followed the instructions in a workbook describing PIPs over an 8-week period and answered a questionnaire. Forty-five per cent felt they had made an improvement in their study habits or lifestyle. Eighty-nine per cent reported that this project helped them to start learning CQI, and 75% reported that they could see the benefit of this kind of knowledge in their future clinical practice. CONCLUSIONS: Personal improvement projects seem to be an effective way of introducing CQI knowledge to nursing students. Even those who did not succeed in achieving personal improvement felt they had a positive learning outcome from the project.

Adult↗
PubMed2006

Optimizing treatment for HIV-infected South African women exposed to single-dose nevirapine: balancing efficacy and cost.

INTRODUCTION: Nevirapine (NVP) resistance may decrease the effectiveness of viral suppression with NVP-based antiretroviral therapy (ART) in women infected with human immunodeficiency virus (HIV) with previous exposure to single-dose NVP. However, the alternative lopinavir-ritonavir-based ART regimen is more expensive. Our objectives were to project the tradeoffs regarding life expectancy, cost, and cost-effectiveness of these ART regimens for NVP-exposed, HIV-infected women in South Africa. METHODS: We developed a simulation model in which NVP-exposed, HIV-infected South African women received 1 of 5 treatment strategies: HIV care without ART, NVP-based ART, lopinavir-ritonavir-based ART, NVP-based ART followed by lopinavir-ritonavir-based ART, or lopinavir-ritonavir-based ART followed by NVP-based ART. The prevalence of NVP resistance was 39%; other data were obtained from the published literature. RESULTS: Projected life expectancy was 43.7 months for women who did not receive ART, 77.4 months for women who received a single NVP-based regimen, and 84.5 months for women who received a single lopinavir-ritonavir-based regimen. NVP resistance reduced survival time by up to 11.6 months among women who received NVP-based ART. The cost-effectiveness of NVP-based ART was $800 (US dollars) per year of life saved, compared with no ART, and the cost-effectiveness of lopinavir-ritonavir-based therapy was $4400 per year of life saved, compared with NVP-based ART. Lopinavir-ritonavir followed by NVP-based ART yielded the greatest life expectancy (105.4 months), had a cost-effectiveness of $2300 per year of life saved, and, if the efficacy of NVP-based regimens improved >6 months postpartum, further increased survival. CONCLUSIONS: NVP resistance substantially decreased the projected survival time associated with NVP-based ART, and lopinavir-ritonavir-based ART resulted in a superior survival time but at higher cost. A sequential regimen starting with lopinavir-ritonavir-based ART followed by NVP-based ART maximized projected survival and was cost effective in South Africa.

Adult↗