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PubMed2005

[The tuberculosis monitoring system in Moscow].

The existing need for objective assessing methods of different reform strategies in the health care system and of the epidemic situation has resulted in the setting-up of monitoring systems as the most efficient and rapid tool to solve health care problems on the evidence basis provided that the primary data are highly valid. Clinical epidemiological methods with monitoring results kept in mind make it possible to search for the optimum approaches to achieving a qualitative, accessible, and effective program for health care delivered to the population. The tuberculosis monitoring system to be introduced in Moscow can pool an information flow at the urban level, furnishes an opportunity to analyze and assess the activities of a phthisiological service, makes it possible to obtain pooled data on areas, to assess the epidemic situation and tuberculosis-controlling work, and to work out and implement antiepidemic measures.

Adolescent↗
PubMed2005

Dyslipidemia and lipodystrophy in HIV-infected Thai children on highly active antiretroviral therapy (HAART).

BACKGROUND: Previous cross sectional studies revealed that dyslipidemia occurs in 50-70% of children receiving highly active antiretroviral therapy (HAART). However, there is no information in children in developing countries where children may have a different nutritional status. OBJECTIVE: To evaluate the incidence and associated risk factors of dyslipidemia following HAART in HIV-infected Thai children. The occurrence of clinical lipodystrophy among these children was also evaluated. MATERIAL AND METHOD: Twenty-three HIV-infected children who initiated HAART from "Access to Care Program" sponsored by MOPH around October 2001. Non-fasting blood tests for lipid profile were performed at enrollment and every 6 months. Triglyceride level was not analysed due to a non-fasting condition. The assessment of clinical lipodystrophy was done every 1-2 months. RESULTS. As of October 2003, 19 (83%) children experienced dyslipidemia. There were 10, 13, 5, and 8 children who had dyslipidemia at 6, 12, 18, and 24 months of HAART The mean total cholesterol, low density lipoprotein (LDL), and high density lipoprotein (HDL) tended to increase over time while the children were on HAART: There was a correlation of elevated total cholesterol and CD4 percentage gain particularly at 18-24 months of treatment (r = 0.596, p = 0.007). Two children developed peripheral lipoatrophy. There were no dyslipidemia-associated risk factors identified. Most of the children had transient abnormal lipid profile. There were only 3 children that had persistent abnormality throughout the 24 months of HAART CONCLUSION: Dyslipidemia was found from 6-12 months of HAART and were mostly transient over time. Peripheral lipoatrophy were found in 2 children. Further follow-up will elucidate the long-term incidence, the association factors, and clinical consequences.

Antiretroviral Therapy, Highly Active↗
PubMed2005

The development of the model for recognition of prior learning for nurses in South Africa: development of RPL guidelines by the policy makers and stakeholders of nursing.

The National Qualifications Framework (NQF) was established to address the compartmentalization of education and training, the absence of norms and standards and the need for international recognition. According to the South African Qualifications Authority (1996),this framework was aimed at developing a comprehensive qualifications structure and an integrated approach to education and training in the country (NCHE, 1996:46). Educational institutions, including those for nursing, were challenged with a view to rethink the whole culture of teaching and learning and was counted as knowledge. The major principle of the NQF was the Recognition of Prior Learning (RPL), which had to be persued across all sectors (Musker, 1998: 8). RPL was seen as a means to widen access into learning programs for those who had been historically denied this. The challenge for educational institutions was how to ensure that RPL systems once implemented did not compromise academic standards. Research into methodologies to implement the NF in the absence of mechanisms was then essential. The purpose of the study was to develop and test a RPL model for nurses in South Africa. The study adopted a multi phase decisions-oriented evaluation research design. Stuffelbeam's educational evaluation model was used to guide data collection and analysis. The research questions were incorporated under the different phases of evaluation. The model was development at six levels: level one was at the policy makers level; level two was at the stakeholders; levels three to six were at institutional level where three institutions participated at pilot site for the RPL model development. These levels are presented as tiers in the figure 1. This article present the results of the model development at the first two levels, which according to Stuffelbeam's model is the context evaluation for boundary setting. Part two will present the model development at institutional level, involving the input and process evaluation and depicted as tiers three, and four.

Clinical Competence↗
PubMed2006

Medication errors with the use of allopurinol and colchicine: a retrospective study of a national, anonymous Internet-accessible error reporting system.

OBJECTIVE: To more closely assess medication errors in gout care, we examined data from a national, Internet-accessible error reporting program over a 5-year reporting period. METHODS: We examined data from the MEDMARX database, covering the period from January 1, 1999 through December 31, 2003. For allopurinol and colchicine, we examined error severity, source, type, contributing factors, and healthcare personnel involved in errors, and we detailed errors resulting in patient harm. Causes of error and the frequency of other error characteristics were compared for gout medications versus other musculoskeletal treatments using the chi-square statistic. RESULTS: Gout medication errors occurred in 39% (n = 273) of facilities participating in the MEDMARX program. Reported errors were predominantly from the inpatient hospital setting and related to the use of allopurinol (n = 524), followed by colchicine (n = 315), probenecid (n = 50), and sulfinpyrazone (n = 2). Compared to errors involving other musculoskeletal treatments, allopurinol and colchicine errors were more often ascribed to problems with physician prescribing (7% for other therapies versus 23-39% for allopurinol and colchicine, p < 0.0001) and less often due to problems with drug administration or nursing error (50% vs 23-27%, p < 0.0001). CONCLUSION: Our results suggest that inappropriate prescribing practices are characteristic of errors occurring with the use of allopurinol and colchicine. Physician prescribing practices are a potential target for quality improvement interventions in gout care.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Physical activity for adolescents with intellectual disability.

Numerous studies have described an association between participation in physical activity and an enhanced sense of well-being. These findings have been documented in both genders across the lifespan. Connections between exercise and positive physical, psychological, emotional and educational outcomes have also been found. New findings indicate that is an ongoing and increasing tendency for sedentary lifestyles across age groups and gender in many countries. In addition, there are many factors that work together to contribute to a sedentary lifestyle in individuals with intellectual and developmental disability (ID/DD). These findings are concerning, and indicate that people with ID/DD are at relatively high risk for the development of multiple negative consequences of physical inactivity. This review presents current literature that addresses the question of physical activity in adolescents with ID/DD. In addition, this review presents the connection between higher levels of physical fitness and better health in youths with ID/DD. Strategies to promote physical activity in the adolescent population with ID/DD are presented. The available evidence base strongly supports the high need for the establishment of community based, easily accessible physical activity programs for children and adolescents with ID/DD.

Activities of Daily Living↗
PubMedDate not supplied

Prediction of surface and interior regions in proteins--Part I: Linear tripeptide sequences identify structural boundaries in proteins.

Previously, using an IBM or compatible program called SurfacePlot, it was shown that amino acid parameters of hydrophilicity, accessibility and flexibility could successfully predict linear accessible or surface regions observed in the x-ray structure of proteins. In addition, these surface regions defined the boundaries of secondary structure regions in proteins. In this paper we show that tripeptides containing the polar residues G K S D E N P T A R and Q also predict surface regions of proteins. Although tripeptides containing these residues predicted 91% of the observed accessible regions, the combination of polar tripeptide predictions with SurfacePlot predictions significantly reduced overpredictions (36% to 17%) and improved accuracy from 71% to 83% while maintaining an 86% prediction rate of observed x-ray-defined linear accessible regions. This new program also predicted 86% of beta-turn regions. The data indicated that not all beta-turns are highly exposed to solvent and that beta-turns should not be used as the sole criteria for defining surface regions.

Algorithms↗
PubMed1990

Current bioethics trends in Canada.

Canadian bioethicists have long enjoyed access to bioethics programs in the United States and have collaborated with U.S. organizations working in this field. Nevertheless, special features of Canada's multicultural society and public health services are increasingly seen as raising distinctive issues requiring special attention. The purpose of this article is to provide an overview of current Canadian bioethics trends in various areas--including those of training, research on human subjects, human reproduction, termination of life, biotechnology, organ transplants, and AIDS. Comparison of this work with other articles in this issue will show that while some of the trends involved have paralleled similar ones in the United States, some trends (such as that regarding confidentiality and the reporting of HIV infection) have been quite different.

Acquired Immunodeficiency Syndrome↗
PubMed1986

[Interactive microcomputer program for calculation and normal values for routine clinical neurophysiological research].

A BASIC program for a 128 KByte microcomputer is described which is deviced to support every day clinical neurophysiological investigations. It provides calculating routines and normal values with a hard copy print option for visual, auditory, and somatosensory evoked potentials, peripheral motor and sensory nerve conduction velocities, and needle EMG potential analysis. All important arm and leg nerves and muscles are included. By its simplicity the program gives easy access to changes according to individual requirements.

Computers↗
PubMed1994

Periodic health examination, 1994 update: 3. Primary and secondary prevention of neural tube defects. Canadian Task Force on the Periodic Health Examination.

OBJECTIVE: To make recommendations on nutritional interventions and screening manoeuvres to prevent the birth of infants with neural tube defects (NTDs). OPTIONS: Folic acid consumption through diet or supplementation in women at low risk and at high risk of having a fetus with an NTD, and maternal serum alpha-fetoprotein (MSAFP) screening in low-risk pregnancies. OUTCOMES: A reduction in the incidence rate of NTDs and potentially harmful effects of false-positive results of screening tests (i.e., abortion of a normal fetus). EVIDENCE: A MEDLINE search with the use of medical subject headings "neural tube defects," "prenatal diagnosis" and "prevention and control" identified 103 original articles published between January 1979 and March 1993. Two reviewers extracted the data by applying the rules of evidence developed by the Canadian Task Force on the Periodic Health Examination. VALUES: The task force's evidence-based methods and values were used; high value was placed on prevention of NTDs and on limitation of the harmful effects of a pregnancy involving a fetus with an NTD. BENEFITS, HARMS AND COSTS: Evidence suggests that folic acid supplementation can decrease the incidence rate of NTDs in low-risk pregnancies by 40% to 60% with no adverse effects. MSAFP screening between the 16th and 18th weeks of gestation can reach a sensitivity of 83% and a specificity of 98% when it is used as part of an organized program. The effect of screening on the incidence rate of NTDs depends on whether affected fetuses are aborted. RECOMMENDATIONS: All women of childbearing age should be advised to increase their consumption of folic acid through diet or supplementation to 0.4 mg/d beginning 1 month before pregnancy and ending at the start of the second trimester. MSAFP screening is recommended in low-risk pregnancies only when it is part of a screening program that includes access to all necessary diagnostic services. High-risk women should be referred to genetic counselling before they plan a pregnancy. VALIDATION: These recommendations are comparable to the current recommendations of the US Centers for Disease Control and Prevention, the Society of Obstetricians and Gynaecologists of Canada, the Canadian Laboratory Centre for Disease Control and the Canadian College of Medical Geneticists, and they were validated through external review. SPONSOR: These guidelines were developed and endorsed by the Canadian task force, which funded by Health Canada.

Canada↗
PubMed1995

Predictors of first-contact care in a poor urban community.

OBJECTIVE: The aim of the study was to identify predictors of first-contact care in a population of poor urban residents. METHODS: Information from a community health needs survey was used for the study. The sample included adult residents in five urban census tracts with a large proportion of Puerto Rican Hispanics. Potential predictors included social characteristics, source of health insurance, perceived health status, number of chronic diseases, use of alternatives to medical care, smoking status, and problems with alcohol use. RESULTS: A total of 826 household interviews were completed for a participation rate of 78% among eligible households. Individuals with no health insurance were six times more likely to lack a source of first-contact care, compared with those who have traditional indemnity insurance. Those who only had Medicaid were four times more likely to lack a source of first-contact care. Respondents involved in Medicaid-managed care programs had similar access to first-contact care as those with commercial insurance. Individuals who reported problems with alcohol were three times more likely to lack a source of first-contact care. CONCLUSIONS: Health insurance is an important predictor of access to first-contact care for poor urban residents. Those who identify problems with alcohol and African-Americans have additional difficulty with access to first-contact care.

Adult↗
PubMed1994

The academic occupational physician as consultant. A 10-year perspective.

The academic community has long served the private sector in a consultant capacity in engineering and in the sciences. With respect to occupational medicine, physicians, when working for industry, have generally practiced in a health care setting. Within the past 10 years, however, the business sector has placed more attention on the health implications of its operations as a result of regulations, liability, and rising health care costs. These issues, which go beyond traditional clinical responsibilities, have furthered the need for businesses to receive strategic medical advice to effectively operate and to maintain a competitive edge. One particular business sector, the chemical industry, has been challenged seriously because of legitimate as well as perceived health risks associated with the production and use of its products. This paper describes the professional experiences over a 10-year period (1983 to 1993) of an occupational physician working as a consultant to an international chemical company. Services have related to epidemiology, health policy, toxicology, plant oversight as well as serving as a health advisor on matters involving the relation between business and health. An academic affiliation with an occupational medicine residency program has facilitated access to related occupational health professionals to assist in problem solving and research. Opportunities for consulting in occupational medicine will depend upon the nature of the organization as well as the personal and professional characteristics of the physician. Requests for these types of services, however, are likely to expand in the near future, primarily as a result of wider awareness of the implications of work on health, increased litigation, and government regulations.

Chemical Industry↗
PubMed1994

Complications of neonatal extracorporeal membrane oxygenation. Collective experience from the Extracorporeal Life Support Organization.

Since 1973, 7667 neonates have been treated with extracorporeal membrane oxygenation for severe respiratory failure and their cases reported to the Extracorporeal Life Support Organization Registry. The overall survival was 81% in these neonates, who were thought to have a survival of 20% without extracorporeal membrane oxygenation. A total of 4322 mechanical complications (0.56 +/- 0.84 per case) and 13,827 patient complications (1.80 +/- 2.12 per case) were reported overall. The most common mechanical complications included clots in the circuit (19%), cannula placement (9%), oxygenator failure (4%), and others (9%). Common patient complications included cardiopulmonary (43%), neurologic (35%), bleeding (35%), metabolic (32%), renal (25%), and renal (25%), and infectious (9%). From the initial experience to 1988 the average number of mechanical complications per case was 0.27 per case and this significantly increased during 1990 to 1992 to 0.75 per case (p < 0.05). Likewise, from 1973-1985 to 1988 the average patient complications per case were 1.44 per case and this significantly increased during 1990 to 1992 to 2.10 per case. During the same periods, patient survival significantly decreased from 84% (1973-1985 to 1988, n = 2463) to 80% (1990 to 1992, n = 4005). Venovenous double-lumen single cannula extracorporeal membrane oxygenation had a higher survival than venoarterial extracorporeal membrane oxygenation (91% versus 81%) and a lower rate of major neurologic complications. The incidence and survival with seizures (6% and 89% venovenous versus 13% and 61% venoarterial) or cerebral infarction (9% and 69% venovenous versus 14% and 46% venoarterial) was significantly lower with the venovenous method and appeared to have a substantial impact on overall survival. The correlation of patient complication rate and total complication rate with survival was highly significant, however, causality cannot be established. Explanations for the increase in complications, relative to a decrease in survival, despite a growing nationwide experience include (1) increased complexity of cases as many programs expand entry criteria (more premature infants, infants with grade 1 or 2 intracranial hemorrhage, and complex congenital diaphragmatic hernia), (2) a growing number of programs with fewer cases per program, yet greater accessibility, (3) less reluctance to report complications encountered during extracorporeal membrane oxygenation as group experience grows, and (4) changes in the Extracorporeal Life Support Organization data form to be more inclusive of more minor complications.

Equipment Failure↗
PubMed1993

Priorities for cancer control in Poland.

Deaths from cancer in Poland are expected to increase by over 60% during the next 20 years due to aging of the population and increasing age-standardized male cancer mortality. Five-year survivals are much lower than in developed Western countries. Improvement of statistics of cancer incidence and survival in different regions of Poland is essential for operational planning of interventions and resources. Reduction of tobacco smoking must remain a priority in prevention. Legislation enforcing protection from carcinogenic workplace exposures and development of monitoring is necessary. Poor performance of primary health care physicians is the major cause of delays in diagnosis. Interventions in this field should focus on professional training and development of units of rapid diagnosis of cancer. Implementation of state-of-the-art treatment through multicenter programs is recommended. Access to specialized treatment, in particular radiotherapy, should be improved through further development of the oncological networks.

Carcinogens, Environmental↗
PubMed1993

Documenting nursing and health care history in the mid-Atlantic region.

The records of health care institutions can be of great value to library patrons. Yet, librarians rarely provide these unique resources because records must be collected, arranged, and described before they can be useful to patrons. The University of Pennsylvania's Center for the Study of the History of Nursing conducted a survey of health care agencies in the mid-Atlantic region to locate records created by area health care institutions. The goals of this project were to develop a database of primary source materials, to place organizational records with enduring value at suitable repositories, and to assist in the development of in-house archival programs at agencies keeping records. In-house programs provide health care institutions with a systematic way to preserve their records for administrative, legal, fiscal, and research use. Such programs also facilitate access to information, reduce cost through records management, and promote an institution through preservation and use of its historical records. The survey demonstrated that record keeping is not coordinated in most institutions, and that institutional awareness of the organization or content of records is minimal.

Archives↗
PubMed1997

Standardized representations of the literature: combining diverse sources of ribosomal data.

We are building a knowledge base (KB) of published structural data on the 30s ribosomal subunit in prokaryotes. Our KB is distinguished by a standardized representation of biological experiments and their results, in a reusable format. It can be accessed by computer programs that exploit the rich interconnections within the data. The KB is designed to support the construction of 3D models of the 30S subunit, as well as the analysis and extension of relevant functional and phylogenetic information. Most published information about the structure of the ubiquitous ribosome focuses on E. coli as a model system. At the same time, thousands of RNA sequences for the ribosome have been gathered and cataloged. The volume and complexity of these data can complicate attempts to separate structural data peculiar to E. coli from data of universal relevance. We have written an application that dynamically queries the KB and the Ribosome Database Project, a repository of ribosomal RNA sequences from other organisms, in order to assess the relevance of structural data to particular organisms. The application uses the RDP alignment to determine whether a set of data refer primarily to conserved, mismatched, or gapped positions. For a set of 16 representative articles evaluated over 211 sequences, 73% of observations have unambiguous translations from E. coli to the other organisms, 21% have somewhat ambiguous translations, and 6% have no translations. There is a wide variation in these numbers over different articles and organisms, confirming that some articles report structural information specific to E. coli while others report information that is quite general.

Artificial Intelligence↗
PubMed1998

Historical origins of current problems in cancer control.

Canada's provinces have some of the most highly developed cancer control systems in the world, but the recent crisis in waiting times for radiotherapy has drawn attention to many weaknesses and inadequacies. Focusing on the province with the largest cancer control system, Ontario, this paper explores the historical origins of current problems in cancer control and shows that they are directly related to policy decisions made in the early years of the system. The development of cancer control in Ontario from the 1920s to the present is outlined, and the historical origins of 3 specific problems related to patient care are discussed: fragmentation of care, which has resulted from an emphasis on radiotherapy rather than comprehensive care and from tensions between the medical profession and government; variation in practice, which can be traced to the empirical origin of much cancer treatment and the slow implementation of research programs; and inequitable access to care, which can be attributed to the emphasis on geographic centralization of services. Attempts to reform Ontario's cancer control system are unlikely to be successful unless these fundamental issues are recognized and addressed.

Comprehensive Health Care↗
PubMedDate not supplied

Charting a course: meeting the challenge of permanency planning for children with incarcerated mothers.

Case workers involved in permanency planning for children whose mothers are incarcerated must assess the family's strengths, the mother's capacity to assume parental responsibilities, and the integrity of the parent-child relationship; and address concerns regarding the short- and long-term effects of the children's socioemotional dislocation and the merits of their retaining a relationship with their mothers. At the same time, correctional policies and practices delineate the nature and extent of contacts with the mother and the mother's access to rehabilitative programs. Agency guidelines, practice tools, and advocacy initiatives must be developed to help practitioners meet these challenges. An initial review of the Adoption and Safe Families Act suggests the need for close monitoring of the impact of its mandates to shorten the time for moving children toward permanency and its weakening of the expectation for "reasonable efforts" to be made to reunify families.

Adult↗
PubMedDate not supplied

Assessing access to care under Medicaid: evidence for the nation and thirteen states.

States have broad latitude in designing their Medicaid programs; this has important implications for access to care. To understand the consequences of state variation, we evaluate, for the nation and for thirteen study states, how well the program is providing access for beneficiaries, using the level of access available to low-income privately insured people in the local health care market as our benchmark. Overall, we find that Medicaid beneficiaries' access matches that of the low-income privately insured for most of the ambulatory outcomes examined but is worse for dental services and prescription drugs. State-level analyses revealed some variation in the access gap.

Adult↗