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PubMed2006

The influence of Israel Health Insurance Law on the Negev Bedouin population--a survey study.

The extension of universal health service insurance to national populations is a relatively new phenomenon. Since 1995, the Israeli National Health Insurance Law (NHIL) has provided universal health services to every resident, but the effect of this law on health and health services among minorities has not been examined sufficiently. The goals of this study were to track some of the first changes engendered by the NHIL among the Negev Bedouin Arabs to examine the effects of universal health care services. Methods included analysis of historical and health policy documents, three field appraisals of health care services (1994, 1995, 1999), a region-wide interview survey of Negev Bedouins (1997), and key informant interviews. For the interview survey, a sample of 515 households was chosen from different Bedouin localities representing major sedentarization stages. Results showed that prior to the NHIL, a substantial proportion of the Negev Bedouins were uninsured with limited, locally available health service. Since 1995, health services, particularly primary care clinics and health manpower, have dramatically expanded. The initial expansion appears to have been a marketing ploy, but real improvements have occurred. There was a high level of health service utilization among the Bedouins in the Negev, especially private medical services, hospitals, and night ambulatory medical services. The NHIL brought change to the structure of health services in Israel, namely the institution of a national health system based on proportional allocation of resources (based on size and age) and open competition in the provision of quality health care. The expansion of the pool of potential members engendered by the new universal coverage had profound effects on the Health Funds' attitudes towards Negev Bedouins. In addition, real consumer choice was introduced for the first time. Although all the health care needs of this rapidly growing population have yet to be met fully, the assurances under the Law and the new level of competition promise a higher level of service in the future.

Adolescent↗
PubMed2006

Dietary and nutraceutical options for managing the hypertriglyceridemic patient.

Scientific evidence continues to accumulate regarding fasting serum triglycerides as an independent risk factor for coronary heart disease. In response, the National Cholesterol Education Program has revised the acceptable level of fasting triglycerides from <200 mg/dL to <150 mg/dL. A significant percentage of Americans suffer from hypertriglyceridemia, and considering the expanding numbers of individuals who are physically inactive, overweight, and suffering from the metabolic syndrome, it is expected that these numbers will continue to rise over the next decade. Fortunately, nutraceutical and lifestyle options have been shown to substantially and consistently reduce this risk factor. This review will focus on management options for the hypertriglyceridemic patient with an emphasis on nicotinic acid, pantethine, fish oils (eicosapentaenoic and docosahexaenoic acids), and modified carbohydrate diets.

Dietary Carbohydrates↗
PubMed1999

Establishing safe injecting rooms in Australia: attitudes of injecting drug users.

OBJECTIVE: To investigate the attitudes of injecting drug users (IDUs) towards the establishment of safe injecting rooms (SIRs) in Melbourne, Australia. METHODS: Multi-site convenience sampling at Needle and Syringe Exchange Programs (NSEPs) within six Melbourne suburbs. Four hundred current IDUs were recruited directly through NSEP and participant snowballing. Respondents completed either a semi-structured interview, anonymous self-report questionnaire, face-to-face interview or participated in a focus group. Participants were asked to report on their knowledge and attitudes about SIR, their experiences and concerns as participants of street-based illicit drug markets, and their willingness to use SIRs if established. RESULTS: Participants (91%) were knowledgeable about the SIR issue and thought such a strategy had potential to address both personal and wider community harms associated with public injecting. Most (77%) indicated they would be willing to use a SIR if established in Melbourne. Gender, lifetime non-fatal overdose episodes and frequency of heroin use were all significantly related to a person's willingness to use SIRs. A significant number also reported a preference for injecting at their own place of residence due to concerns regarding privacy, safety and police presence within street-based market places. CONCLUSIONS: This study has identified a number of important issues relating to the likely demand and uptake of SIRs that should be addressed when considering the feasibility of establishing SIRs within Australia.

Adolescent↗
PubMed2001

Cervical screening by socio-economic status in Australia.

OBJECTIVES: To examine differentials and time trends in self-reported Pap test rates by socio-economic status (SES) from the 1989/90 and 1995 Australian National Health Surveys (NHS). METHODS: The unit record data for females were extracted from the two NHSs and combined. The outcome variable of interest was 'having a Pap test in the past three years'. The principal study factor was SES measured as individual characteristics and SES of area of residence. Migrant status, rurality, year of survey and age were controlled for in logistic regression models. RESULTS: Self-reported rates of having a Pap test in the past three years were higher in women from higher compared with lower SES groups. Compared with women with a bachelor or higher degree, the odds of reporting having a Pap test in the past three years in women with no post-school qualification was 0.86 (p<0.0005). Women with a gross annual income of less than $20,000 had significantly lower odds (OR=0.79) compared with women earning $40,000 or more. Blue collar (OR=0.84) and not employed (OR=0.73) women also had significantly lower odds compared to the referent white collar group. CONCLUSION: This study reveals differentials in Pap screening behaviour by individual measures of SES in Australia. Area-based SES measures under-estimated the SES differentials in Pap test rates compared with individual measures. Derived population attributable fractions reveal that about a quarter of self-reported under-screening is accounted for by low SES when measured individually, compared to 8% when SES is measured ecologically.

Australia↗
PubMed2005

Infections after coronary artery bypass graft surgery in Victorian hospitals--VICNISS Hospital Acquired Infection Surveillance.

OBJECTIVE: To establish a surveillance program reporting surgical site infection rates after coronary artery bypass graft surgery (CABGS) in Victorian public hospitals. METHODS: The VICNISS Coordinating Centre was established in 2002 to implement and co-ordinate a standardised surveillance system for hospital-acquired infections in acute care Victorian public hospitals. Using validated definitions and methodology from the Centers for Disease Control and Prevention's National Nosocomial Infection Surveillance (NNIS) program, data on risk-adjusted surgical site infection (SSI) rates were collected and submitted to the Coordinating Centre for collation and reporting. RESULTS: Six large Melbourne metropolitan hospitals contributed data for CABGS for the period 11 November 2002 to 30 June 2004, comprising a total of 3,482 patient records. Of 3,398 complete records, the aggregate SSI rates per 100 procedures for NNIS risk category 1 and 2 were 4.4 (95% Cl 3.7-5.3) and 6.0 (95% Cl 4.5-7.8) respectively. The deep sternal SSI rates were 0.6 (95% Cl 0.4-1.3) and 0.5 (95% Cl 0.5-2.4 for patients in risk category 1 and 2 respectively. The most common pathogen identified was Staphylococcus aureus. CONCLUSION: This early data from VICNISS demonstrates similar CABGS SSI rates to those reported by NNIS in the USA, but higher than reported by the German Nosocomial Infection Surveillance System. IMPLICATIONS: The adoption of a statewide, co-ordinated surveillance program using validated internationally accepted methodologies allows hospitals to benchmark their infection rates against aggregate local and international data and to examine infection prevention interventions.

Adult↗
PubMedDate not supplied

High prevalence of target organ damage in young, African American inner-city men with hypertension.

Young, urban, African American men are at particularly high risk of hypertension and its cardiovascular complications. Left ventricular hypertrophy and renal dysfunction are manifestations of target organ damage from hypertension that predict adverse cardiovascular events. The subjects of this study were 309 African American men, age 18-54 years, with hypertension, residing in inner-city Baltimore. Echocardiograms, electrocardiograms, serum creatinine, and the urinary albumin-creatinine ratio were obtained to evaluate hypertensive target organ damage. Fifty-three percent of the men reported use of antihypertensive medications, of whom 80% were on monotherapy. Calcium channel blockers were used most frequently. The mean echocardiographic left ventricular mass was 211+/-68 g, with a prevalence of echocardiographic left ventricular hypertrophy of 30%. There were 14 men (5%) with extremely high left ventricular mass, >350 grams. Left ventricular systolic dysfunction was seen in 9% of the men with uncontrolled hypertension, and none of the men with controlled hypertension (p=0.02). Renal dysfunction was found in 12% of the subjects, and microalbuminuria or gross proteinuria in 34%. The authors conclude that there is a high prevalence of cardiac and renal abnormalities in inner-city African American men with hypertension, especially in men on antihypertensive therapy with uncontrolled hypertension. It is imperative that cost-effective medications and culturally acceptable health care delivery programs be developed, tested, and integrated into health systems, with strategies specifically relevant to this high-risk population, to decrease the largely preventable morbidity and mortality associated with hypertension.

Adolescent↗
PubMed1995

Is community screening for amblyopia possible, or appropriate?

Photoscreeners are becoming increasingly available and are being widely used to screen for visual abnormalities in young children. However, consideration of accepted criteria for screening programs indicates there is still much further research that needs to be carried out before amblyopia screening could be recommended as a routine component of a community health surveillance program--an adequate description of the potential consequences of an individual developing amblyopia has yet to be provided and the natural history of the condition and factors that determine the effectiveness of treatment have yet to be fully described. While there is the promise of technology that satisfies specific test requirements, this still needs to be trialed in community settings and community trials are required before it will be possible to determine whether the costs that will be incurred in carrying out routine screening and in providing the resources for treatment are warranted. In conclusion, the development of new and possibly more effective technology for screening is only part of the answer to the amblyopia question. While superficially this technology makes screening for amblyopia a possibility, we do not know at this stage whether or not it is appropriate.

Amblyopia↗
PubMed1989

Teaching effectiveness analysis plan applied to lectures in medical physiology.

To improve and thus strengthen its teaching program, the Department of Physiology at the University of South Alabama voluntarily embarked on a multiphasic self-assessment of its medical teaching program. One phase of the greater assessment plan included an analysis of the teaching methods of each faculty member. To design and implement this phase, the services of a teaching consultant from the College of Education were obtained. The implementation of the objectives as established by the consultant resulted in 1) the development of a systematic and consistent method of evaluating the teaching practices of the faculty through the design of a standard observation instrument for use in analyzing the teaching of each individual; 2) the sampling of the teaching of each of the seven participating faculty members; 3) the collection and critical review of teaching materials used; 4) an analysis of the effectiveness of the faculty; and 5) the submission of a written report of evaluation results. The seven participating faculty members were observed during the delivery of two lectures each presented to the freshman medical class. Based on the analysis of both the lectures and materials used, a written critique of each faculty member was submitted. Lecture strengths and weaknesses, both of individual members and of the whole department were summarized. Finally, the results of a survey taken of the faculty in which the participants were asked to respond to a series of questions regarding the self-assessment program were most favorably accepted by all participating faculty.

Alabama↗
PubMed1984

Adenomectomy in a patient on regular dialysis treatment.

A 55-year-old patient presented with terminal renal insufficiency caused by lower urinary tract obstruction due to prostatic adenoma. The case history of the patient on regular dialysis treatment was complicated by recurrent, therapy-resistant urinary tract infections accompanied by septic fever outbreaks and anemic relapses. Following suprapubic transvesical adenomectomy, no fever episodes, negative urine cultures and improvement in the anemic condition were all noted. Due to the fact that the upper age limit for acceptance into a hemodialysis program and possible kidney transplantation has been raised, it is important to note that an increasing number of men with prostatic adenomas may be encountered in these collectives. Dialysis patients require successful treatment of urinary tract obstructions prior to transplantation. Immunosuppressive therapy which follows transplantation increases the risk of infection which can endanger the graft and the patient's life.

Humans↗
PubMedDate not supplied

Hypertension and the Department of Health and Human Services.

Hypertension affects from 17% to 25% of all Americans. Because of its fundamental charge to help protect the public health, the Department of Health and Human Services (HHS) is substantially concerned with the condition. Additionally, hypertension represents a significant source of underwriting risk to which HHS is exposed in its role as health insurer of the poor and the elderly. HHS has invested hundreds of millions of dollars in hypertension research, development and testing of treatment regimens, and education of health care providers and consumers. However, much of the etiology of hypertension still eludes us. Sodium's apparent importance as a "causal" agent to the development of hypertension, and in its treatment, has waxed and waned over the past several generations; research to date has not yet finally settled the issue. Is sodium or some other cation the key? While research on this issue continues, HHS is currently faced with deciding whether and how to require inclusion of sodium content in nutrition labelling. In the debate, attention has to be given not only to the current best evidence on sodium; additional issues of consumer choice, costs, and education are also of importance.

Aged↗
PubMed1999

Human immunodeficiency virus and the outcome of treatment for new and recurrent pulmonary tuberculosis in African patients.

The purpose of this study was to evaluate the impact of human immunodeficiency virus (HIV) infection on treatment for tuberculosis (TB). The study population comprised 28,522 black Southern African gold miners. Patients with sputum culture-positive new or recurrent pulmonary TB diagnosed in 1995 were prospectively enrolled in the cohort. Directly observed therapy (DOT) was practiced and outcomes were assessed at 6 mo after treatment was begun. There were 376 cases of TB (incidence 1,318 per 100,000), of which 190 (50%) were HIV positive and 82 (22%) had recurrent TB. There was no association between HIV status and history of previous TB or drug resistance. Neither the treatment interruption rate (2%) nor the rate at which patients transferred out of the treatment program (1.6%) were associated with HIV status. Excluding deaths, cure rates were similar for HIV-positive and HIV-negative patients (89% versus 88%), but significantly lower in those with recurrent than in those with new TB (77% versus 92%). Mortality was 0.5% in HIV-negative patients versus 13.7% in HIV-positive patients, and in the latter group was associated with CD4(+) lymphocyte depletion. Autopsy examination showed that in HIV-positive patients, early mortality was due to TB whereas late deaths were most commonly due to cryptococcal pneumonia. The study showed that a well-run TB control program can result in acceptable cure rates even in a population with a very high incidence of TB and HIV infection. Particular vigilance is needed for concurrent infections, which may contribute significantly to mortality during treatment of TB in HIV-positive patients.

AIDS-Related Opportunistic Infections↗
PubMed1975

Tuberculosis care in general hospitals: Arizona's experience.

In June 1973 the state of Arizona transferred all in-hospital care of patients with tuberculosis from the State Sanatorium to general hospitals. Eleven general hospitals, 2 extended care facilities, and 30 physicians are under contract; the state pays billed charges after payment from any third-party insurers. Admission to the Tuberculosis Hospitalization Program is controlled by the state and requires real evidence of need for hospital care; there are no residency or indigency requirements. During the first 2 years of the program, 279 patients were admitted for hospital care. The average length of stay was 23.6 days; a marked decrease from the 93-day average in the sanatorium in 1971-1972. Of the 274 patients discharged during the first 2 years, 232 had a final diagnosis of tuberculosis; 105 of these were discharged with sputum smears positive for acid-fast bacilli. Although the cost per patient day was higher than in the sanatorium, the average cost of hospitalization per patient was lower because of the decrease in length of stay. Thirty-five per cent of the patients had some insurance coverage and/or Medicare. An employee skin testing program was required in all hospitals participating in the program. Although there was a 3.5 per cent conversion rate among all hospital employees, there were only 5 converters among employees exposed to patients with tuberculosis under the program. None of the employees was found to have tuberculosis. Of 70 patients with active tuberculosis who have been followed 12 to 24 months, 65 are bacteriologically negative. The general hospital program has been well accepted by patients, physicians, hospitals, and the public.

Adult↗
PubMed1981

Changing public attitudes about the mentally ill in the community.

The public's often negative response to two decades of deinstitutionalization policies remains a substantial barrier to the integration of the mentally ill into the community. Both mental health policymakers and public education specialists must support new programs to promote public acceptance. To do this, new research on the linkages between public attitudes and public behaviors is needed. Two research agendas should be established. First, there must be more specific research on how public attitudes about the mentally ill translate into community receptivity. Second, research must determine whether collaborative approaches to attitude-behavior change--involving communities in the process of changing themselves--or structural approaches--utilizing legal and social pressures--are more effective in promoting community integration.

Attitude to Health↗
PubMed1981

The monitoring of saliva drug levels: psychiatric applications.

An overview is presented of the status of human saliva as a clinical monitoring medium in medicine and psychiatry. Despite the present controversy about the reliability of saliva lithium levels, an evaluation of the prospects of saliva for other pharmacokinetic estimations as well is recommended. The second part of the paper outlines the authors' attempt to expand the use of saliva monitoring in a depot neuroleptic clinic and a methadone maintenance program. This technique, well accepted by the patient populations, is found useful as a screening tool for drug use and compliance can be checked. It can also be indicated prior to the evaluation of the toxicity of prescribed medication as well as the assessment of drug interaction. On humanitarian, clinical and economical grounds, further investigation of the clinical applications of saliva in psychiatric practice is warranted.

Adult↗