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PURPOSE: The American Urological Association convened the Female Stress Urinary Incontinence Clinical Guidelines Panel to analyze the literature regarding surgical procedures for treating stress urinary incontinence in the otherwise healthy female subject and to make practice recommendations based on the treatment outcomes data. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles through 1993 on surgical treatment of female stress urinary incontinence. Outcomes data were extracted from articles accepted after panel review. The data were then meta-analyzed to produce outcome estimates for alternative surgical procedures. RESULTS: The data indicate that after 48 months retropubic suspensions and slings appear to be more efficacious than transvaginal suspensions, and also more efficacious than anterior repairs. The literature suggests higher complication rates when synthetic materials are used for slings. CONCLUSIONS: The panel found sufficient acceptable long-term outcomes data (longer than 48 months) to conclude that surgical treatment of female stress urinary incontinence is effective, offering a long-term cure in a significant percentage of women. The evidence supports surgery as initial therapy and as a secondary form of therapy after failure of other treatments for stress urinary incontinence. Retropubic suspensions and slings are the most efficacious procedures for long-term success (based on cure/dry rates). However, in the panel's opinion retropubic suspensions and sling procedures are associated with slightly higher complication rates, including longer convalescence and postoperative voiding dysfunction.
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This paper summarizes research findings from members of the Southwest Medical Sociology Ad Hoc Committee concerning sociocultural barriers to medical care among Mexican Americans in Texas. Committee members individually, or in two-person groups, studied a number of factors concerning Mexican-American medical care in Texas such as: 1) mortality, morbidity, and other health status indicators; 2) health manpower and educational needs; 3) political factors impeding economical health care; 4) alienation, familism, and their relationship to utilization of the health services; 5) language and communication barriers; and 6) folk medicine. Findings include documentation that structural alienation of Mexican-Americans from mainstream Anglo-American middle-class society is carried over into their relation with utilization of the health care delivery system; that their emphasis on familism works alternatively to encourage and discourage their seeking access to health care; the language differences serve to perpetuate certain cultural differences that are inimical to health care delivery; and that curanderismo can be seen as complementing other types of health care. The report concludes with a number of recommendations for accomplishing cultural integration that will lead to better care for this segment of the health population.
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The worksite is an ideal forum for cancer risk assessment. We describe here the baseline characteristics of a large cohort. Participants completed surveys that assessed a variety of risk factors and behavioral mediators. Personalized feedback letters identified cancer risks. A total of 4395 surveys were received. Cancer prevalence was 6.5% (range, 4.3% to 11.2%). The most common risk factors were lack of exercise (41%; 32% to 68%), obesity (28%; 24% to 39%), and smoking (14%; 13% to 32%). Cardiovascular risk was also common (25%; 15% to 48%). Screening was fair to good for all cancers except colon cancer. The perceived risk for cancer was less than that for cardiovascular disease (P < 0.0001). Most smokers were in the pre-contemplation phase, whereas action/maintenance phases predominated for breast and colon cancer screening. Modifiable cancer risk factors can be identified in the majority of workers. Inaccurate risk perception is an important target for future interventions.
BACKGROUND: Almost 10 years ago, the Careers in Trauma Committee of the Eastern Association for the Surgery of Trauma (EAST) identified four main problems with trauma fellowships: (1) lack of specified educational objectives, (2) undefined curricula, (3) inconsistent emphasis on research, and (4) inconsistent surgical exposure. These perceived problems still exist and may threaten the future of trauma surgery as a career. The objective of this study was to examine these issues in a profile of the current active clinical trauma care fellowship training programs. METHODS: The database foundation was the Trauma Fellowships Listing at the EAST Web site (http://www.east.org). All active clinical trauma training programs on this list were identified, and descriptive information was updated and abstracted. A supplemental survey was sent to each program contact person with specific questions regarding program organization, educational material, fellow responsibilities, and scholarly opportunities. In 2003, the entire database was updated, and the survey process was repeated. RESULTS: The number of active trauma care fellowship programs was 39 (1996), 43 (1999), and 50 (2003). From 1996 to 2003, 15 new programs came into existence, and 4 programs became inactive. Current programs are located in 23 states, Washington DC, Canada, and Australia. California has seven; Pennsylvania has four; and three states have three programs each. The annual trauma admissions for most programs (42 of 50, 84%) vary between 750 and 4,000, with six programs admitting more than 4,000. The most common program format (20 of 50, 40%) offers combined trauma and critical care training, whereas only three programs (6%) offer a choice of trauma only, critical care only, or combined trauma and critical care. A Residency Review Committee (RRC)-approved surgical critical care program was an integral component in 54% (1996), 76% (1999), and 78% (2003). The majority of programs (39 of 50, 78%) are of 1-year duration, with some (22 of 50, 44%) having an optional second year. Most programs (40 of 50, 80%) have one or two positions per year, with the largest program having eight fellows per year. The total number of positions available per year was 66 (1996), 89 (1999), and 95 (2003). Most fellows lead and direct a team of residents and medical students. More programs reported that fellows direct the initial resuscitation of all trauma patients admitted, and more programs are requiring in-house call requirements for fellows. CONCLUSIONS: There is steady growth in trauma fellowship training, with an emphasis on direct clinical management. An RRC-approved surgical critical care program is an important link, but one not essential to the trauma fellowship. Expected radical changes in surgical and trauma training are on the horizon. It is imperative that leaders in trauma surgery continue to monitor these trends for successful integration of trauma care training into surgical residency redesign efforts, and for facilitation of programmatic improvement in trauma care as a career.
The International Working Group on Harmonization of Dementia Drug Guidelines has held the third Asia-Pacific Chapter meeting in 2004. The committee concludes that the Neuropsychiatric Inventory and the Clinical Dementia Rating are culturally acceptable assessment tools. The epidemiology studies of mild cognitive impairment and dementia in Asia were discussed at the meeting. The committee encouraged a collaborative research in the region in the future.
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