[The spreading of Marxist ideas and their transition into communism in the area of public health in Latin America].
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Communism↗
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Are overweight asthmatics more difficult to control?
The relationship between asthma and obesity appears to be quite complex. The aim of this study was to assess the effect of excess weight on asthma control evolution in a cohort of asthmatics. A prospective database was set up, which enrolled adult asthmatics with persistent (mild, moderate or severe) asthma. The control of asthma was defined as a binary variable, acceptable or unacceptable. In order to evaluate the effect of body mass index (BMI; <25 or > or =25), data were analysed using a continuous time homogeneous Markov model in which the forces ruling the transition between the two health states were estimated. The following confounding covariates were also evaluated in the model: severity of asthma, current treatment with oral corticosteroids (OCS) and history of OCS over the year preceding inclusion. About 406 asthmatics were included who made a total of 1639 consultations; the median length of follow up was 182 days. Using a univariate model, overweight patients had a lower risk of transiting from the unacceptable to the acceptable health state (RR = 0.45; P < 0.01). The effect of weight remained significant (RR = 0.53; P < 0.01) in the multivariate model including the other covariates. Moreover, transition probabilities stabilized more rapidly for patients with BMI < 25 (200 vs 300 days). In this study, we thus demonstrated that there is an association between excess weight and transition from unacceptable to acceptable control. Because control of asthma clearly drives asthma management, this finding has consequences for defining original new strategies for managing asthma in overweight patients.
Adrenal Cortex Hormones↗
The new subjective medicine: taking the patient's point of view on health care and health.
Calls to respect patient autonomy and produce patient-centered outcomes have recently brought the patient's point of view back into the center of clinical medicine. Bioethics has argued that patient values must be respected in health care decisions. But it has generally not questioned medicine's goals, including its definition of health. For bioethics, health has remained an objective biological fact. However, pressures to improve the cost-effectiveness of medical care have increased interest in the subjective health and quality of life of patients. Perceived health, health-related quality of life, and health-state utilities bring health assessment progressively closer to the patient's perspective. Now even death's harm to patients is qualified by the value patients place on their health state. Medicine's epidemiological transition from acute to chronic disease is thus prompting an epistemological transition from primarily objective to primarily subjective evidence of health and health care effectiveness. Now some of the most important patient outcomes, like patient choices before them, are valid because they are subjective. Pathophysiology is appropriately becoming a means to produce health as it is defined from the patient's point of view. The physicians' job description will be changed to focus on patients' lives rather than patients' bodies. Definitive evaluations of medical effectiveness will occur within patients' lives rather than within doctors' hospitals. This further incorporation of patient subjectivity should carry us well beyond informed consent and the other protections for patient autonomy bequeathed to us by bioethics.
Bioethics↗
Oral health behavior and attitudes of adults in Lithuania.
In Lithuania, the oral health system is currently in transition and systematic data are needed for public oral health care planning. The objectives of this study were (i) to describe the self-assessment of oral health status in Lithuanian adults, the oral hygiene practices, and dental visiting habits; (ii) to assess the attitudes towards teeth and oral health, dental care and oral health services; (iii) to determine whether oral health attitudes and behavior are affected by socio-economic factors; and (iv) to analyse the association between self-care practices and use of oral health services. The study comprised random samples of 35-44-year-olds (n = 381) and 65-74-year-olds (n = 302). Data were collected during 1997 98 by means of self-administered questionnaires and the response rate was 53%. Nearly all persons of ages 35-44 had natural teeth, whereas 14% of 65-74-year-olds were edentulous. Among the dentate persons, 45% of the young adults against 36% of the elderly claimed having poor teeth, and 66% and 55%, respectively, had experience of pain from teeth or mouth during the past year. At ages 35-44, 33% of participants reported toothbrushing at least twice a day and this was the case for 21% of 65-74-year-olds. Dental visits within the past year were indicated by 60% of young adults and 43% of the elderly; 83% of all participants reported that their last visit to the dentist was due to acute oral symptoms. In general, the participants had positive dental knowledge and attitudes; however, 56% were unaware of any effect of fluoride. The bivariate analyses showed that perceived oral health status and oral self-care practices were related to use of dental services. The multivariate analyses of dental visiting habits revealed the effects of gender, urbanization, presence of natural teeth, experience of dental problems, attitudes to dental care and dentists, and education. In conclusion, preventive dental services should be introduced and the establishment of community-based oral health promotion programs is urgently needed for Lithuania.
Adult↗
Recombinant human neurotrophic factors accelerate colonic transit and relieve constipation in humans.
BACKGROUND & AIMS: The aim of this study was to assess the effects of recombinant human brain-derived neurotrophic factor (r-metHuBDNF) and recombinant human neurotrophic factor 3 (r-metHuNT-3) on gastrointestinal motor functions in healthy people and in patients with constipation. METHODS: Gastrointestinal and colonic transit was measured by scintigraphy before and after 2 weeks of treatment. Daily diaries documented symptoms over 6 weeks before, during, and after treatment. In a randomized study of healthy subjects, 40 received 100 microg/kg r-metHuBDNF or placebo subcutaneously (SC) daily. In a separate study, 8 healthy subjects and 8 patients with constipation received 300 microg/kg r-metHuNT-3 SC thrice weekly. RESULTS: r-met-HuBDNF accelerated overall and proximal colonic emptying (P<0.05) in health. r-metHuNT-3 accelerated overall colonic transit in health and constipation (all P<0.05) and gastric and small bowel transit (both P<0.05) in health. r-metHuBDNF tended to increase stool frequency compared with placebo in health (P = 0.09). r-metHuNT-3 increased stool frequency (P = 0.05) and facilitated passage of stool (P < 0.01) in constipated patients. The effects on stool frequency started within 3 days of the beginning of neurotrophin administrations and lasted up to 5 days after treatment ended. r-metHu neurotrophic factors were well tolerated, although half of the participants in the 2 studies developed injection site reactions or paresthesiae. CONCLUSIONS: Exogenous neurotrophic factors stimulate human gut motility in health and constipation.
Adult↗
Access to health care: health insurance considerations for young adults with special health care needs/disabilities.
Youth with special health care needs/disabilities want what all youth in America want: independence, health, friends, and jobs. Yet, between 19 and 23 years of age (depending on the state), youth with special health care needs/disabilities often find little availability of health insurance or health providers that were an essential part of why they survived and now are looking to participate in adult society. This article reviews the complex system of health insurance options that young adults with special health care needs/disabilities face as they move from pediatric to adult health insurance systems. Yet because of a maze of different eligibility criteria, many of these options are not available to young adults with special health care needs, and they are left with out health insurance. Similarly, the issues surrounding health provider reimbursement often leave the young adult with special health care needs without health care professionals who can manage their complex health conditions as they transition into adulthood. In conclusion, this article outlines what steps could be taken by associations and the health policy, advocacy, and governmental communities to improve the situation.
Adolescent↗
Health in the central and eastern countries of the WHO European Region: an overview.
The enormous social, political and economic changes that began in the CCEE/NIS in the late 1980s included the revelation and public discussion of a widening health gap between these countries and the other Member States of the European Region. The continuing economic problems and their effects on health increase the urgency of the need for assistance from the international community. Diverging trends in life expectancy became evident in the mid-1970s, and the gap continued to widen in the 1980s for all major causes of death, particularly cardiovascular diseases. The situation is worse in the NIS than in the CCEE, and worst in the central Asian countries. In 1990, the worst infant mortality rate in these countries was eight times the best rate elsewhere in the Region. Non-mortality data, while patchy, confirm the indications given by mortality data. There is no single reason for the health gap, but contributory factors include the increasing prevalence of major risk factors in lifestyles and the environment, and the low efficiency and effectiveness of health care systems. The current situation and short-term prospects are mixed, but the negative trends in mortality and morbidity patterns are likely to continue for some time. While the worst health problems of the transition period in the CCEE/NIS could largely have been avoided, there is no doubt that economizing on health today will exact large costs tomorrow.
Europe↗
Public health consequences from hazardous substances acutely released during rail transit--South Carolina, 2005; selected States, 1999-2004.
On January 6, 2005, two freight trains collided in Graniteville, South Carolina (approximately 10 miles northeast of Augusta, Georgia), releasing an estimated 11,500 gallons of chlorine gas, which caused nine deaths and sent at least 529 persons seeking medical treatment for possible chlorine exposure. The incident prompted the Agency for Toxic Substances and Disease Registry (ATSDR) to review data from its Hazardous Substances Emergency Events Surveillance (HSEES) system and update an analysis of 1993-1998 railroad events. The HSEES system is used to collect and analyze data concerning the public health consequences (e.g., morbidity, mortality, and evacuations) associated with hazardous-substance--release events that occur in facilities or during transportation. This report describes the event in South Carolina, which is not part of the HSEES system, and two others from HSEES, and summarizes all rail events reported to HSEES from 16 state health departments during 1999-2004. Local government agencies, employers, and first responders can help reduce morbidity and mortality from transit-associated hazardous-substance releases by examining historical spill data for planning purposes, developing emergency response plans, undergoing proper hazardous materials (HazMat) training, and reviewing epidemiologic investigation data.
Accidents↗
Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition.
This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality.
Data Collection↗
[The prognostic significance of the ultrasonic study of osmophilic lamellar myelin bodies in chronic cystitis and transitional-cell bladder tumors].
Electron microscopy studies revealed three possibilities in the formation of osmophilic lamellar myelin figures and indicated ways for their elimination. In health states and in transitional cell papillomas, low-grade transitional cell carcinoma of urinary bladder, the osmophilic lamellar myelin figures are comparatively less common. In chronic cystitis, high-grade transitional cell carcinoma of the urinary bladder as well as in moderately malignant and non-differentiable ones, the osmophilic lamellar myelin figures counts get markedly increased, which fact suggests that the study of the above figures may have both general biological as well as differential diagnostic and prognostic significance.
Carcinoma↗
Human resources for health in Palestine: a policy analysis. Part I: Current situation and recent developments.
Human Resources for Health Development (HRD) has been a priority and focus of attention in the Palestinian healthcare system since the changeover of authority on the system at the end of 1994. This analysis examines HRD between 1994 and 2001. The aim is to provide an insight into and better understanding of the issue in a conflicting and transitional context. The results of this analysis are presented in two parts. Part I looks at the current situation and recent developments in Human Resources for Health (HRH) in Palestine. On the one hand, it analyses the relationship between HRH deficiencies and major policy options and strategies. On the other hand, it examines the correlation between HRH policy development and the policy context. Particular attention is given to the links between national health policy priorities and health sector reform initiatives. Part II focuses on the process of HRH policy formulation and implementation.
Arabs↗
[Changes in health politics].
In the last 25 years we observed in health politics an impressive transition, always more important became money. The big majority of physicians is not interested in politics, neither in health politics, they permit, that there is made politics with them. Often the "health war" (Clausewitz) is more important for them than "the art of the possible" (Bismark). There are many groups and many competences, but until now everybody forgot to allot the competences clearly to the different groups. Decisions are made with few competence, with "an empty brain". Additional services are demanded for the same money, as Mrs. Dreifuss of the Swiss Federal Council does. She wishes the neutrality of cost, but more services.
Cost-Benefit Analysis↗
The role of foreign direct investment in the nutrition transition.
OBJECTIVE: To examine the role of foreign direct investment (FDI) in the nutrition transition, focusing on highly processed foods. DESIGN: Data on FDI were identified from reports/databases and then compiled and analysed. A review of published literature on FDI into the food sector was conducted. SETTING: The nutrition transition is a public health concern owing to its connection with the rising burden of obesity and diet-related chronic diseases in developing countries. Global health leaders are calling for action to address the threat. Highly processed foods often have considerable fat, sugar and salt content, and warrant closer examination. RESULTS: FDI into food processing, service and retail has risen rapidly since the 1980s, mainly from transnational food companies (TFCs) in developed countries. As FDI has risen, so has the proportion invested in highly processed foods for sale in the host market. FDI has proved more effective than trade in generating sales of highly processed foods, and enables TFCs to cut costs, gain market power and obtain efficiencies in distribution and marketing. The amount of FDI targeted at developing countries is increasing; while a disproportionate share enters the larger developing economies, foreign affiliates of TFCs are among the largest companies in low- and low- to middle-income countries. The effect of FDI is to make more highly processed foods available to more people. FDI has made it possible to lower prices, open up new purchasing channels, optimise the effectiveness of marketing and advertising, and increase sales. CONCLUSION: FDI has been a key mechanism in shaping the global market for highly processed foods. Notwithstanding the role of demand-side factors, it has played a role in the nutrition transition by enabling and promoting the consumption of these foods in developing countries. Empirical data on consumption patterns of highly processed foods in developing countries are critically needed, but since FDI is a long-term investment vehicle, it is reasonable to assume that availability and consumption of highly processed foods will continue to increase. FDI can, however, bring considerable benefits as well as risks. Through its position 'upstream', FDI would therefore be an appropriate entry-point to implement a range of public health policies to 'redirect' the nutrition transition.
Commerce↗
Mental health triage in emergency medicine.
OBJECTIVE: The aim of this study was to: (i) develop a triage scale consistent with the National Triage Scale (NTS) for patients with mental health problems attending emergency departments; and (ii) to reduce emergency waiting times, transit times and improve skills assessing mental health problems. METHOD: We developed a Mental Health Triage Scale (MHTS) consistent with the NTS. The MHTS was then implemented using a structured education package, and evaluated from March to August 1994. Further evaluation occurred after 2 years. RESULTS: A four-tiered MHTS was produced: category 2, violent, aggressive or suicidal, danger to self or others or with police escort; category 3, very distressed or psychotic, likely to deteriorate, situational crisis, danger to self or others; category 4, long-standing semi-urgent mental health disorder, supporting agency present; and category 5, long-standing non-acute mental health disorder, no support agency present. Patients with illness, injury or self-harm were triaged using combined mental health and medical information. Mean emergency waiting times and transit times were reduced. More consistent triaging for mental health patients occurred, and more consistent admission rates by urgency. Reduced mental health 'did not waits' showed improved customer satisfaction. Mental Health Triage Scale was considered appropriate by liaison psychiatry and its use has continued at 2 years follow-up. CONCLUSIONS: A systematic approach to mental health triaging produced a workable scale, reduced waiting times, transit times, and provided effective and consistent integration of mental health patients into a general emergency department.
Australia↗
Relationship between soft tissue body composition and bone mass in perimenopausal women.
OBJECTIVES: Perimenopause, the transition into menopause, marks the beginning of accelerated bone loss, contributing to the development of osteoporosis, a major public health problem. This perimenopausal transition has also been associated with a decrease in body lean mass, an increase in fat mass, and an increase in body weight. How these changes in fat mass and lean mass may influence bone mineral density (BMD) is currently unknown. The purpose of this study is to determine the independent effect and relative contribution of lean mass and fat mass to BMD in perimenopausal women. MATERIAL AND METHODS: The sample consisted of 43 sedentary perimenopausal women (age: mean = 49.6; S.D. = 3.2) with an intact uterus and ovaries, participating in a study of exercise and perimenopausal symptoms. Total body BMD, regional BMD, and soft tissue body composition were measured by dual-energy X-ray absorptiometry. Other measures including age, height, weight, and serum FSH and E2 were also obtained. RESULTS: Findings revealed that 14% of these perimenopausal women had low bone mass (osteopenia) in the lumbar spine and/or the femoral neck. Overall body fat mass and lean mass had positive relationships with BMD of lumber spine and the femur. However, using multiple regression analyses, only lean mass and ethnicity remained significant predictors for BMD of the femoral neck (r2 = 45%) with lean mass explaining more variance than ethnicity. Lean mass was the sole predictor of total proximal femur BMD explaining 38% of the variance. Fat mass was not a significant predictor of BMD at any skeleton site. CONCLUSIONS: These findings suggest that body lean mass, not fat mass, is a significant contributor to femoral BMD in perimenopausal women.
Absorptiometry, Photon↗
Transition of cognitively delayed adolescent organ transplant recipients to adult care.
Transition from pediatric to adult health care is a complicated process that goes far beyond transfer of care. The young person who is intellectually impaired or who must struggle to master daily living skills faces more challenges in this process than other adolescents. Physicians, nurses, social workers, occupational therapists, and other health care providers must work with adolescents, their parents, and teachers to assess abilities and transition needs. Communication skills, capacity for decision making, adherence, vocational and educational issues, sexuality, and relationships should be addressed. Interventions may include the creation of an individualized transition plan, skills training, family counseling, a lengthened transition process, involvement in a support group, health promotion, and teaching of self-care skills. The summary for the adult provider should include information about how best to communicate with the young person and an assessment of capacity to make decisions and self-management skills.
Adolescent↗
Obesity and risk knowledge.
Obesity is an epidemic health problem in many developed countries, and it is an emerging public health concern in developing, transitional, and newly developed countries. The purpose of this research is to investigate the relationship between individuals' knowledge concerning the health risks of obesity and their tendency to be obese (as measured by the "body mass index"). Instead of assuming that obesity is a pure physiological problem as in previous studies, we allow an individual's cost/benefit evaluation to play a role. Based on survey data from Taiwan, we investigate the relationship with the quantile regression technique. The results suggest that such a relationship does exist and it is different for males and females.
Aged↗
["Tellus", the Earth as a patient: global health status--a diagnostic approach].
The article presents important health problems in developing countries from a doctor's perspective. The poor health of people in developing countries does not exist in a vacuum. It is closely interlinked with poverty, high fertility and environmental issues. In this context, dominating medical problems are the health problems of women in connection with pregnancy and childbearing, and the results of the vicious cycle of malnutrition and infection in children. After discussing some problems in developing countries, the author considers key health problems in societies in transition. This "doctor's perspective" must be balanced with the health concerns of community itself.
Adult↗