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PubMed1994

Traineeship in diabetes and the older patient. A public health experience.

The author describes an effort that demonstrates a successful partnership between a professional education program in podiatric medicine, the Pennsylvania State Health Department, and the Professional Diabetes Academy, which served as the catalyst for health promotion, prevention, and education. Similar programs through adaptations geared to local resources could be developed as a demonstration of direct secondary prevention of the complications of diabetes in the older population and have the potential to help meet national goals to significantly reduce amputations.

Diabetes Mellitus↗
PubMed1999

Tuberculosis prevention and control activities in the United States: an overview of the organization of tuberculosis services.

After a 20% increase in tuberculosis (TB) cases between 1986 and 1992, TB cases in the United States have declined from 1993 through 1997, an average of 5 to 7 per cent per year. In this paper, we review trends and the current epidemiology of TB in the US, present a brief history of TB control efforts in the country, and present the key strategies for TB control in the US. We describe the current organizational structure of TB services in the US, the role of the private sector in TB control, and how TB control is funded. Finally we discuss the mechanisms by which TB policy is developed. The US model represents a categorical disease program that combines a centralized role of the national government in development of policy, funding, and in the maintenance of national surveillance, and a decentralized role of state and local jurisdictions, which adapt and implement national guidelines and which are responsible for day-to-day program activities. Given the relative success of this combined approach, other countries facing the challenge of maintaining an effective TB control program in the face of increased decentralization of health services may find this description useful.

Adolescent↗
PubMed2000

[Prevention in pulmonology].

In the fight against respiratory diseases the well established most effective strategy is their prevention. Mainly the field of screening-caring--so called the second and third levels in prevention--belongs to the competency of the pulmonology specialty, while the key-issue of primary prevention consisting of the reduction of environmental harm and health education is not--or at least not only--the responsibility of the health care system. In the light of national epidemiological data BCG vaccination of the new-born is necessary, however, the system of revaccination of school-age children needs revision. The system of chest screening by rtg nowadays is adapted to the local prevalence of tuberculosis; it is needed to concentrate to high-risk subjects. The effectivity of radiological screening now is recognised internationally and this perspective partly based on our national results. In the care of patients with chronic obstructive pulmonary diseases (COPD) the key-issue is the identification and regular follow-up, care of high-risk subjects with rapid decrease in lung function by effective screening. The most important issue in this work is smoking cessation. Of course, if we could prevent smoking addiction, we could significantly reduce the number of several other widespread diseases, not only lung cancer.

BCG Vaccine↗
PubMed2001

[Immune deficiencies: diagnosis, management, some perspectives].

Severe primary immunodeficiencies (PID) are rare; their global incidence is comparable to that of childhood leukemia; they include more than 100 different entities. Clinical manifestations are: unusually severe or frequent infections or infections that do not respond to adequate treatment; an increased risk of certain malignancies; sometimes auto-immune manifestations. Delayed diagnosis and management of PID can lead to severe and irreversible complications or to death. PID can become manifest only in the adult; in common variable immune deficiency, the median age at diagnosis is between the 2nd and the 3rd decade of life. PID are often transmitted genetically; recent progresses in molecular biology have allowed more precise and earlier, including antenatal, diagnosis. Molecular treatment of 3 infants with a severe immunodeficiency has recently been achieved in April 2000. Those progresses were mostly based on the study of immunodeficiency databases. We present here the work of a Belgian group specialized in PID; meetings have started in June 1997. This group establishes guidelines for the diagnosis and treatment of PID, adapted to the local situation. The elaboration of a national register of PID is also underway; this has to provide all guaranties of anonymity to patients and families. Such a register already exists at the European level; it has provided the basis for new diagnostic and therapeutic possibilities. The inclusion of Belgian data in this register should allow essential progresses essential for our patients.

Adolescent↗
PubMedDate not supplied

Advancement flap plasty for the closure of anal and recto-vaginal fistulas in Crohn's disease.

The management of anal fistulas in patients with IBD continues to be extremely challenging and, indeed, somewhat frustrating. Despite a global closure rate of about 75%, all patients should be informed about the risk of infection, early failure, eventual temporary disfunctioning stoma and the possibility of late recurrence (about 15%). Closure of a RVF in Crohn's disease should not be considered an easy undertaking, especially in patients with several Crohn localisations. The technique can be adapted to the local situation. Construction of a temporary stoma is not mandatory. However, stoma construction seems to be beneficial when extensive perianal or recto-vaginal dissection including eventual tissue interposition is required. Advancement flaps are an attractive surgical alternative for the management of all anal transsphincteric fistulas, also in Crohn's disease, because sphincter architecture and function are well preserved. Improved medical treatment and the changed approach from conservative to reparative surgery may well have resulted in a decreased need or at least in a delay of the need for a proctectomy. Although the surgical principles of advancement flap techniques are sound, these techniques have not been used for many decades. Skills needed, problematic approach, suboptimal quality of local tissues have contributed to its selective use and to the absence of prospective randomised studies.

Crohn Disease↗
PubMed2001

[Common lumbago and returning to work: various thoughts about a complex problem].

Non specific low back pain (NSLBP) is commonly a persistent or recurrent problem. In general the longer a worker is off work with NSLBP, the more disabling the condition becomes, the less successful any form of treatment, and the greater the probability of long term sickness absence. The obstacles to return to work are diverse. Scientific evidence shows that the development of chronic low back pain and disability depends more on individual and work-related psychosocial issues than on physical or clinical features. There is strong empirical evidence that treatment at the subacute stage (NSLBP lasting for approximately 5-12 weeks) is more effective at preventing chronic pain and disability than attempts to treat chronic intractable pain and disability once it is established. Active rehabilitation programmes should be interdisciplinary, adapted to the local socioeconomic context and include education toward overcoming fear avoidance beliefs and promoting self-care, some kind of active exercises, some behavioural principles of pain management, and some intervention at the workplace to help and assist the worker in early return to work. Some of these programs have produced desirable occupational outcomes when all the stakeholders in the disability problem (worker, employer, insurer, attending physician) worked together.

Chronic Disease↗
PubMedDate not supplied

[Management of aneurysms of the hepatic artery. 15 patients].

OBJECTIVES: There appears to be an increasing number of patients with aneurysm of the hepatic artery. We report a retrospective analysis of management schemes used in a single hospital unit over the last 14 years. PATIENTS AND METHODS: Clinical data on all patients with aneurysm of the hepatic artery, treated in Edouard-Herriot hospital (Lyon, France) from 1985 to 1999, were reviewed. RESULTS: There were 15 patients with 16 aneurysms. Mean patient age was 56 years with no gender predominance. The aneurysm was a fortuitous discovery in 8 of the patients. There were 10 cases of pseudoaneurysm and 6 cases of true aneurysm. Treatment was adapted to the local anatomy and the patient's status. Surgery was used for 5 patients and radiologic embolization for 4. Observation was indicated in 5 patients and spontaneous thrombosis occurred in 1. Mean duration of observation was 24 months. Six patients were lost to follow-up and 2 died from their primary disease. DISCUSSION: Surgery is the treatment of choice for aneurysms situated in an extrahepatic localization while radiologic embolization is appropriate for intrahepatic localizations. Close cooperation between the surgery and radiology teams was most contributive to proper management in our series, providing favorable outcome.

Adult↗
PubMed2001

Chronic respiratory diseases in developing countries: the burden and strategies for prevention and management.

In developing countries, chronic respiratory diseases represent a challenge to public health because of their frequency, severity, projected trends, and economic impact. Health care planners, for example, are faced with a dramatic increase in tobacco use and must establish priorities for the allocation of limited resources. Nevertheless, smoking prevention and standardized management programmes for asthma and chronic obstructive pulmonary disease should be implemented in developing countries whenever possible. International measures will be required to reverse tobacco smoking trends, and international agencies could define essential drugs and equipment and encourage the use of generic drugs, particularly for corticosteroids inhaled at high dosages. For such programmes to be effective, producers of high-quality generics will need to be identified, and the medications added to national lists of essential drugs and included in procurement procedures. Other recommendations for alleviating the burden of chronic respiratory diseases in developing countries are: adapting guidelines to local contexts and ensuring their distribution; upgrading equipment at district level; purchasing high-quality drugs at low prices; routine training and supervision of health services personnel; and regular monitoring of performance. Social mobilization by professional societies, nongovernmental organizations, and the mass media will also increase government commitment to tobacco control and standardized case management.

Anti-Asthmatic Agents↗
PubMed2001

[The dynamic changes of NOSmRNA in endothelial cells of aortae and pulmonary arteries in rats under tail suspension].

Objective. Through the observations of dynamic changes of eNOSmRNA and iNOSmRNA in arterial endothelial cells of systematic circulation and pulmonary circulation under simulated weightlessness, to collect some data for studies of the adaptive mechanisms of local regulation in arterial systems. Method. Wistar rats were -30 degrees tail suspended to simulate the effects of weightlessness. The rats were randomly divided into three groups: control group (CON), 7-day tail suspension group (TS7) and 14-day tail suspension group (TS14). Changes of NOSmRNA expresses in endothelial cells of the thoracic aortae and pulmonary arteries were observed with in situ hybridization technique. Result. The eNOSmRNA and iNOSmRNA of thoracic aortic and pulmonary arterial endothelial cells in TS7 rats increased very significantly. The eNOSmRNA of thoracic aortic endothelial cells from TS14 rats returned to control level, but remained very significantly increased in pulmonary arteries. The iNOSmRNA in pulmonary arterial endothelial cells from TS14 rats decreased very significantly, but that in thoracic aortae returned to the control level. Conclusion. The responses of eNOSmRNA and iNOSmRNA in arterial endothelial cells of systematic circulation to tail suspension were similar, but they were different in pulmonary arterial endothelial cells, which might be due to the difference in the peak course of the shift of fluid from lower body entering the pulmonary or systematic circulation during initial period of simulated weightlessness. It could be a kind of important sign of depressed local regulative function under simulated weightlessness and might contribute to orthostatic intolerance after simulated weightlessness.

Animals↗
PubMed2002

Muddy perceptions/dirty water: messages for clearing the visions of the public and the powerful.

Globalism does not usually work when it comes to spreading the word about water! There is no one formula for explaining water issues to the public or to public officials. Sometimes you should go to reporters. Sometimes you should focus on educating editors. Sometimes you concentrate on educating teachers, sometimes the business community, bureaucrats or elected officials. Sometimes your message concentrates on fisheries, sometimes health, sometimes tourism. Often, you will want to emphasize something else--even sales of genetic material that might be dependent on biodiversity. In short, your message must be adapted to the local circumstance. Your methodology will depend on whether you must stimulate immediate action, or whether you have the luxury of pushing a longer-term message. The Web opens many new possibilities. Cost of Web distribution is low. The Web offers a combination of many effective storytelling tools such as audio, video, and animation. Multi-lingual materials are easier to prepare than for film. But at this stage of Web development it may be more efficient to provide material to existing publications' Web sites and to NGOs and official sites, than to establish special stand-alone Web sites. I propose a "resource" Web site for those who have responsibility for water projects. The site would contain articles and explanatory material provided by media organizations, attracted by a modest contest-and-prize system.

Commerce↗
PubMed2002

Community outreach: a call for community action.

For a variety of reasons, end-stage renal disease disproportionately affects minority populations. Factors such as socioeconomic status, cultural differences, and genetic variations, are all involved. In addition, there are often real and perceived barriers for these patient groups in fully accessing the healthcare system. Thus, there is a real need for the development of specific outreach programs that target these high-risk communities. In developing such programs, it is important to realize that there is not a homogeneous 'ethnic community', but rather, like any large demographic grouping, a diverse population. These differing communities will all have different requirements and needs and, thus, outreach programs need to be wide-ranging and adapted for individual, local communities, to ensure that all target audiences are reached. The core aims for these outreach programs must be raising disease awareness and education among minority patients. To achieve this goal, a wide range of organizations need to be actively involved, including national and--importantly--local, community-based patient organizations, and hospital management corporations, as well as local radio and television companies to advertise the outreach initiatives. However, any outreach campaign will need to be combined with policy changes and further research into kidney disease among minority groups if real improvements in outcomes are to be achieved.

Community-Institutional Relations↗
PubMed2002

[Penile prostheses and infection].

Infection of penile prostheses, estimated to occur in 3% of cases, represent the major complication of this type of prosthesis. Early sepsis occurs during the first week and presents in the form of frank clinical features (pain, erythema, penile discharge); highly virulent bacteria are isolated, such as Staphylococcus aureus. Late sepsis occurs after an interval of several weeks to several months with less specific clinical features; Staphylococcus epidermidis is isolated in more than 50% of cases. Conventional treatment of these infections consists of antibiotics adapted to the local flora and removal of the prosthesis, sometimes followed by deferred reimplantation. Prosthetic material salvage procedures are now proposed. Patient-related risk factors for infection include diabetes, urinary tract infection and immunodepression, while procedure-related risk factors include the length of hospital stay, poor operative technique, prolonged operating time and iatrogenic urethral injuries. Prevention of sepsis of penile prostheses is based on prevention of these risk factors and prophylactic antibiotics or prolonged antibiotic therapy.

Bacterial Infections↗
PubMed2002

Membrane dosing units for chemicals in water and wastewater treatment plants.

It is well known that in the practice of the drinking water as well as of the wastewater treatment especially for the processes of pH-regulation, flocculation, precipitation or disinfection, the dosing of reagents is necessary. The costs of the automatic dosing stations are comparatively high. For the smaller water treatment plants these stations are uneconomical and charged with maintenance problems very often. In many cases the frequently observed highly fluctuating reagents needs and the recess between can cause disruption of the normal exploitation work. These disadvantages can easily be overcome by a device based on permeable or semi-permeable membranes. The use of semi-permeable membranes is favourable especially in the cases of fluctuating water quantities or standstills. It can be effective because of the possibility for their self-regulation during the dosing. When there is no inflow available some kind of concentration equilibrium is established between the internal and external membrane layers. This system is easy to install and it can be easily adapted to the local conditions. The device can be a canister filled with the desired reagent and covered with a lid of a definite semi-permeable membrane. After determining the permeability of the membranes made of different materials only the appropriate membrane area is important to be determined. Developed methods for defining the specific membrane permeability are discussed in the paper. Suggestions for the application of such devices in practice are given as well.

Disinfectants↗
PubMed2003

An ultrastructural demonstration of NADPH-diaphorase/nitric oxide synthase activity in the rat striatal astroglia.

In the present study we have used electron microscopical NADPH-diaphorase (NADPH-d) histochemistry as a visualization procedure for nitric oxide synthase (NOS) to examine patterns of activity in the subcellular distribution of NADPH-d in the rat striatal astroglia. Electron microscopical examination revealed deposition of the NADPH-d reaction product in a nuclear envelope, fragments of endoplasmic reticulum and mitochondria. Predominantly mitochondria of astrocytic "end feet" were labelled. Our ultrastructural observations promote the possibility that astroglial NADPH-d/NOS is involved in adaptation of the local blood flow in the striatal microenvironment.

Animals↗
PubMedDate not supplied

Patient complaints: guidance for nurses.

In response to the debate at RCN Congress in 1990, the College has produced the following guidelines for good practice on handling complaints about care, treatment and services. These guidelines have been written to help nurses, midwives and health visitors to handle complaints in ways which are fair to patients and in which they feel confident. The principles are readily applicable to other disciplines and an effective complaints procedure can only be established on a multidisciplinary basis. They may be used and adapted to form local policies and should be considered in conjunction with the recommendations of the Association of Community Health Councils and government recommendations and proposals to improve patients' satisfaction and confidence in health care services.

Humans↗
PubMed2003

Rheology of the microcirculation.

The main function of the microvasculature is the controlled exchange of materials with surrounding tissues. This necessitates a large vessel surface established by a high number of vessels with small diameters and thus an inherently high individual resistance to flow. The hydrodynamic resistance of a microvascular network with given angioarchitecture depends on the apparent viscosity of blood flowing in the microvessels. Apparent viscosity declines with decreasing diameter (the Fahraeus-Lindqvist effect) and is minimal at diameters of about 5-7 micrometers due to the optimal alignment of red cells with the flow. In vivo, a number of additional phenomena influence blood rheology and network hemodynamics. The distribution of blood flow and red cell flux within networks is influenced by the mechanics of red cell motion at individual diverging bifurcations (phase-separation effect). Furthermore, recent studies have revealed the presence of a thick endothelial surface layer ( approximately 0.5 micrometers) on the luminal surface of microvessels which is attached to the endothelial glycocalyx. This layer modulates flow resistance and may be relevant for a number of other processes such as inflammatory responses and blood coagulation. Information on microvascular rheology can be used to develop mathematical models of network hemodynamics and vascular adaptation to the local environment (angioadaptation), to investigate the complex interrelated mechanisms which establish and maintain functionally adequate microvascular networks.

Animals↗
PubMed2003

Comprehensive functional specifications and design for IT support of clinical research at an academic medical center.

We present a framework for understanding and developing an Information Technology (IT) infrastructure for human subject research. First, we review the process of clinical research in an academic medical center. Next,we describe the entities,roles,and functional relationships within the clinical research enterprise to define a conceptual data model. Finally, we address design and implementation issues for an IT infrastructure that can be adapted to the local needs of research institutions.

Academic Medical Centers↗
PubMed2004

[Schistosomiasis Control in Sub-Saharan Africa. Proceedings of a round table, Lisbon, Portugal, September 9, 2002].

The Round Table organized by the Société de pathologie exotique during the 3rd European Congress on Tropical medicine and International Health held in Lisbon on September 9, 2002 has been attended by a hundred participants. Five communications were presented and followed by a debate concerning the main aspects of the epidemiology and the control of schistosomiasis in sub-Saharan Africa. The necessity of studying intermediate hosts to identify vectors, some of which being able to colonize new areas or to modify their susceptibility to parasites, has been emphasized. The population is infected during water contacts and Poda et al. showed the importance of water projects, necessary for the development of poor countries, but facilitating the transmission of schistosomiasis. Most current activities force the population to use stagnant water However, it is well known that children are more infected, with severe clinical and functional consequences. The contamination of the environment is linked to hygienic practices. Sow et al. demonstrated that usually recommended solutions are inappropriate. Latrines, for example, are notably sub-used by some at risk groups because culturally unsuitable and considered as avoiding discretion or comfort. Besides the technical improvement which can be proposed, education by the parents and the teachers must begin from the youngest age. Ernould et al. showed the strong heterogeneity of schistosomiasis transmission in water projects due notably to the distance between habitations and transmission sites as well as modalities of use and maintenance of the irrigation system. In this respect, the communication of Poda et al. showed that schistosomiasis was underestimated by the health system due to the lack of training of health staff, poor equipment of health centers and low awareness of both populations and political authorities. Garba et al. confirmed the efficiency of mass treatments with praziquantel, even with a low therapeutic coverage. The renewal of the treatment can be adapted to the intensity of the transmission. The modeling of the performances of the hematuria test described by Etard allows to adjust the sample of population participating to a survey. Other indicators must be proposed to estimate the efficiency of the strategy of control and, possibly, to adapt it to local constraints. Ultrasonographic scores have been proved as faithful and specific indicators for clinical surveillance of complications. Several participants evoked the promising experimental results of candidate vaccines against schistosomiasis and noticed delay taken by clinical trials. The weakness of the financial support postponed considerably the development of the vaccines which interests a numerous population but unable to pay for them. Participants insisted on health education, hygiene, construction or modernization of infrastructures and sanitation which, together, will guarantee durability. Mass treatment with praziquantel appears as a method, certainly indispensable at this stage, but which must be transient. A wide consensus emerged in favor of a community based and integrated control strategies organized at peripheral level in association with technical services (health, hydraulics, agriculture, education) and local governments. Although schistosomiasis seems not to drain any more financial supports, restricting human and scientific resources mobilization of industrial countries, this Round Table underlined the dynamism of researches performed by sub-Saharan African scientists.

Africa South of the Sahara↗