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PubMed1985

Mortality patterns in the modernized Pacific Island nation of Nauru.

Nauru is a small phosphate-rich independent island country situated in the Central Pacific. The population is Micronesian and was estimated to be 4,680 in mid-1981. An analysis of mortality data for the years 1976-81 indicates a high adult male mortality due to accidents, injuries, cardiovascular disease, and diabetes. The life expectancy estimate at birth for men was 49 years, and for women 62 years. The male life expectancy is among the lowest in the region. The considerable adult male mortality appears to be related to the rapidly acquired affluence and the ready availability of motorcycles, cars, imported foods, tobacco, and alcohol. The data suggest that modernization of the economy in Pacific Island nations can lead to new and serious public health problems.

Accidents↗

PubMed1996

Traditional epidemiology, modern epidemiology, and public health.

There have been significant developments in epidemiologic methodology during the past century, including changes in basic concepts, methods of data analysis, and methods of exposure measurement. However, the rise of modern epidemiology has been a mixed blessing, and the new paradigm has major shortcomings, both in public health and in scientific terms. The changes in the paradigm have not been neutral but have rather helped change--and have reflected changes in--the way in which epidemiologists think about health and disease. The key issue has been the shift in the level of analysis from the population to the individual. Epidemiology has largely ceased to function as part of a multidisciplinary approach to understanding the causation of disease in populations and has become a set of generic methods for measuring associations of exposure and disease in individuals. This reductionist approach focuses on the individual, blames the victim, and produces interventions that can be harmful. We seem to be using more and more advanced technology to study more and more trivial issues, while the major causes of disease are ignored. Epidemiology must reintegrate itself into public health and must rediscover the population perspective.

Epidemiology↗

PubMed2006

Impact of the Medicare Prescription Drug Improvement and Modernization Act on the management of colorectal cancer.

PURPOSE: The potential impact of changes in reimbursement for drugs and biologicals associated with the Medicare Prescription Drug Improvement and Modernization Act (MMA) on the management of colorectal cancer is described from the perspectives of health care providers and patients. SUMMARY: The introduction of new chemotherapeutic agents and supportive therapies over the past several decades has increased survival in patients with colorectal cancer. The changes in reimbursement for these therapies associated with MMA may affect the financial viability of private physician office practices and hospital-based outpatient clinics where such therapies are administered. The MMA-related changes also have the potential to decrease patient access to treatment and adversely affect treatment choices, scheduling, and outcomes. CONCLUSION: The reimbursement changes brought about by implementation of MMA could affect health care delivery and patient care.

Antineoplastic Agents↗

PubMed2006

Effect of the Medicare Prescription Drug Improvement and Modernization Act on the bottom line.

PURPOSE: An historical perspective on the impact of the Medicare Prescription Drug Improvement and Modernization Act (MMA) on pharmaceutical reimbursement, and the financial bottom line at health systems and various strategies to use in the inpatient and outpatient setting to improve the bottom line are described. SUMMARY: Implementation of MMA has affected the entire healthcare continuum by reducing pharmaceutical reimbursement rates and health system revenues and increasing prescription drug copayments, emergency department visits, and hospital admissions. Physician-owned clinics are less profitable than in the past because of MMA, which may prompt clinic closures and shift the patient care burden to clinics at public hospitals. Negotiating carve-outs for costly drugs and evaluating the feasibility of obtaining outlier payments can improve the bottom line in the hospital inpatient setting. Ensuring that billing codes are accurate and verifying that reimbursement was received can help minimize the impact of MMA on the financial bottom line in the outpatient setting. Negotiating favorable purchasing contracts and ensuring that drugs are used appropriately by following evidence-based guidelines can improve the financial bottom line in both the inpatient and outpatient settings. CONCLUSION: Strategies to decrease drug acquisition costs and increase reimbursement rates can help minimize the adverse impact of MMA on the financial bottom line at health systems.

Ambulatory Care Facilities↗

PubMed1999

Pharmacokinetic factors in the modern drug treatment of tuberculosis.

Tuberculosis is increasing in prevalence throughout the world, particularly in sub-Saharan Africa, Asia and Latin America. This resurgence can partly be attributed to increasing poverty, particularly in developing countries, and the human immunodeficiency virus (HIV) pandemic. However, there is also increasing concern at the development of multidrug-resistant tuberculosis caused by the misuse of the agents available. The modern treatment of patients with tuberculosis should start, in most cases, with 4 first-line agents in order to minimise the risk of drug resistance developing. A6-month drug regimen is usually satisfactory for pulmonary and nonpulmonary tuberculosis, although not for patients with tuberculous meningitis, in whom a longer course of treatment is required. Coinfection with HIV may produce an atypical clinical and radiological presentation, but the treatment regimen is essentially similar to other situations. Several of the first-line agents, in particular rifampicin (rifampin) and isoniazid, are likely to cause clinically significant drug interactions and/or toxicity, particularly in patients with HIV infection. Consideration of the pharmacodynamic and pharmacokinetic interactions between the host, the mycobacterium and the drug may contribute to the development of pharmacokinetically optimised regimens that make best use of the existing range of antituberculosis drugs. However, such idealised regimens need to be tested in prospective clinical trials. The use of therapeutic drug monitoring in selected groups of patients may improve outcomes, avoid drug toxicity and reduce the development of multidrug-resistant tuberculosis. The management of multidrug-resistant tuberculosis requires a high level of clinical expertise and such patients should start on at least 5 drugs to which the organism is thought to be susceptible. Up to 50% of patients with tuberculosis may not adhere to their drug regimen, resulting in persisting infectiousness, relapse or the development of drug resistance. Directly observed treatment with antituberculosis drugs, combined with a serious commitment to tuberculosis control, is required if we are to combat this increasing epidemic.

Antitubercular Agents↗

PubMed2006

The role of pharmacognosy in modern medicine and pharmacy.

This review details the contribution to modern medicine and pharmacy made by natural products and drugs derived from natural products, with an emphasis on essential medicines and new introductions to the market. Areas covered include recent advances in the development of drugs derived from marine organisms, microbes, terrestrial animals, and vascular plants, and current issues regarding botanical medicines. The role of natural products in drug discovery and development is evaluated, particularly with regard to their value as sources of drug leads with "drug-like" properties. A rationale for the success of natural products research in providing new drugs and drug prototypes is presented, drawing on lines of evidence from chemical informatics and chemical ecology. Several innovative strategies for natural products drug discovery and evaluation of botanical medicines are also reviewed.

Animals↗

PubMedDate not supplied

Modernization and status change among aged men and women.

This study investigates the differences between the relationship between elderly occupational status and modernization for men and women. Consonant with previous findings, it finds that economic development is associated with relative losses of elderly men in professional and technical occupations. Augmenting those findings, however, it finds an even stronger association between development and such losses for women. In accounting for the differences, several explanations are advanced and tested, using data from fifty-one nations.

Aged↗

PubMed1985

Brazil: the health care model of the military modernizers and technocrats.

Post-1964 political changes in Brazil had dire implications for the health sector as successive governments pursued economic and social policies which aggravated inequities and benefitted narrow elites. The "military modernizers" embraced a concept of development inimical to basic human needs, an economic model favoring growth over distribution and development over social welfare, and budget priorities favoring vocal, urban middle sectors at the expense of marginal populations. The result was deteriorating health and social conditions among the majority of the population that did not share in the benefits of the "economic miracle."

Brazil↗

PubMed2025

Transforming Medical Education to Make Patient Safety Part of the Genome of a Modern Health Care Worker.

Medical education has not traditionally recognized patient safety as a core subject. To foster a culture of patient safety and enhance psychological safety, it is essential to address the barriers and facilitators that currently impact the development and delivery of medical education curricula. The aim of including patient safety and psychological safety competencies in education curricula is to insert these into the genome of the modern health care worker.

Patient Safety↗

PubMed1986

Modern imaging and endoscopic biopsy techniques in Egyptian mummies.

Egyptian mummies have been popular subjects of radiographic investigation since 1896. Computed tomography (CT) and magnetic resonance imaging (MRI) have recently been added to the growing list of modern techniques used to study these relics. The Minnesota Mummy Project was organized to examine four well preserved Egyptian mummies dating from the XVIIIth (1575-1308 B.C.) and XXVth (715-663 B.C.) Dynasties. Plain radiographs and CT scans were obtained on all specimens. One individual was selected for additional endoscopic and microscopic correlation with CT findings in the thoracic cavity. The collapsed heart was identified by CT. A percutaneous biopsy of the heart was then performed with a flexible fiberoptic endoscope, passed through a small hole drilled into the chest wall. Microscopy of prepared ventricular specimens revealed striated muscle fibers consistent with myocardium. These results emphasize the utility of CT as a noninvasive paleoradiologic tool. Another mummy was examined by MRI to search for minute quantities of residual moisture possibly trapped within the desiccated tissues. Only a free-induction-decay signal could be obtained, but this was insufficient to generate an image. Thus, it appears that present MRI is not suitable for the paleopathologic investigation of dehydrated structures.

Biopsy↗

PubMed2005

[Modern aspects of shoulder injury treatment].

The article describes injuries of soft and bone structures of the shoulder region, with special emphasis on the following clinical forms: instabilities and luxations of the glenohumeral joint, fractures of the proximal humerus, clavicle and the states of painful shoulder. Fractures and dislocations, but also significant entities - painful states caused not only by fractures but also by minor trauma such as tendinitises and m.supraspinatus tendon and bicipital tendon ruptures are discussed in more detail. Moreover, their consequences - painful and stiff shoulder - as well as modern diagnostic and therapeutic procedures applied in the painful shoulder treatment are also discussed.

Humans↗

PubMed2003

Signs of nephropathy may occur early in young adults with diabetes despite modern diabetes management: results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS).

OBJECTIVE: To estimate the occurrence of early-onset renal involvement in a nationwide population-based cohort of young adults with diabetes in Sweden and relate the findings to glycemic control, type of diabetes, sex, smoking, and blood pressure. RESEARCH DESIGN AND METHODS: The Diabetes Incidence Study in Sweden aims to register all incident cases of diabetes in the age-group 15-34 years. In 1987-1988, 806 patients were reported and invited to participate in a follow-up study focusing on microvascular complications. Of them, 469 subjects participated. The assessment was based on questionnaires (n = 469), blood samples (n = 424), urine samples (n = 251) and, when appropriate, medical records (n = 186). RESULTS: During the follow-up time, median 9 years (range 6-12), 31 of 469 patients (6.6%) with incipient or overt diabetic nephropathy (i.e., micro- or macroalbuminuria) were found, 24 of 426 (5.6%) in type 1 and 7 of 43 (16%) in type 2 diabetic subjects (P = 0.016). Additionally, 24 of 31 patients (77%) had microalbuminuria and 7 (23%) had macroalbuminuria, which mainly occurred in patients with type 2 diabetes. In a Cox regression analysis, high mean HbA(1c) during the follow-up period and high blood pressure at follow-up increased the risk of developing signs of nephropathy (P = 0.020 and P = 0.003, respectively). Compared with patients with type 1 diabetes, those with type 2 diabetes tended to have an increased risk of renal involvement (P = 0.054) when adjusting for sex, tobacco use, glycemic control, and blood pressure. CONCLUSIONS: Despite modern treatment and self-monitoring of blood glucose, young adult patients with diabetes may still develop renal involvement during the first 10 years of diabetes duration. Inadequate HbA(1c), high blood pressure, and type 2 diabetes appear to be risk markers for early occurrence of diabetic nephropathy.

Adolescent↗

PubMed2004

Growth performance of nursery pigs fed diets containing increasing levels of corn distiller's dried grains with solubles originating from a modern Midwestern ethanol plant.

Two experiments were conducted to determine the effects of including distiller's dried grains with solubles in nursery diets on growth performance, and to establish maximum inclusion rates for corn distiller's dried grains with solubles originating from modern, "new-generation" ethanol plants (built since 1990). Ninety-six crossbred pigs (BW = 6.18 +/- 0.14 kg) were blocked by gender and ancestry, and pigs within each block were randomly assigned to one of six dietary treatments (four pigs/pen, four pens/dietary treatment) in each of two growth performance experiments. Dietary treatments provided 0, 5, 10, 15, 20, or 25% distiller's dried grains with solubles during Phases 2 and 3 of a three-phase nursery feeding program for early-weaned pigs. Pigs in Exp. 1 were slightly older (19.0 vs. 16.9 d of age) and heavier (7.10 vs. 5.26 kg) at the beginning of the experiment compared to pigs in Exp. 2. All pigs in both experiments were provided a commercial pelleted Phase 1 diet for the first 4 d after weaning and were then switched to their respective experimental Phase 2 diets, which were fed for 14 d, followed by their respective Phase 3 experimental diets, which were fed for a subsequent 21-d feeding period. Experimental diets were formulated to contain equivalent apparent ileal digestible lysine (1.35 and 1.15%), apparent ileal digestible methionine + cystine (0.80 and 0.65%), ME (3,340 and 3,390 kcal/kg), calcium (0.95 and 0.80%), and total phosphorus (0.80 and 0.70%) within Phases 2 and 3, respectively. Overall growth rate, ending body weight, and feed conversion were similar among pigs regardless of dietary distiller's dried grains with solubles level for both experiments. In Exp. 1, feed intake was not affected by dietary treatment (P > 0.10). In Exp. 2, however, increasing the level of distiller's dried grains with solubles linearly decreased feed intake (P < 0.02) during Phase 2 and tended to decrease voluntary feed intake (P < 0.09) over the length of the experiment. These results suggest that the corn distiller's dried grains with solubles used in this study can be included in Phase 3 diets for nursery pigs at dietary levels of up to 25% without negatively affecting growth performance after a 2-wk acclimation period. Including high levels of corn distiller's dried grains with solubles in diets for pigs weighing less than 7 kg in BW, however, may negatively influence feed intake and growth.

Aging↗

PubMedDate not supplied

Modern methods for measurement of basilar membrane displacements.

Basilar membrane displacements in response to sound at threshold intensities are in the fractional Angstrom range. Visual measurements, as used by Bekesy in his pioneering studies, are by definition limited to values above 10 000 A. The present paper discusses a number of modern techniques capable of taking measurements at lower Anstrom levels: One-point methods (capacitive probe, Mossbauer effect, laser interferometry, and optical heterodyne spectroscopy) and pattern-assessing methods (time-averaged and real-time holography). Advantages and disadvantages of these methods are being discussed.

Acoustic Stimulation↗

PubMed1992

Modern imaging methods in oncology.

Modern imaging methods are very important in the management of patients with cancer and of their disease. It is vital that clinicians treating them understand the relevance of different imaging techniques for specific applications, so that the best choice can be made to aid diagnosis and monitor response to treatment. This review briefly covers the development and principles of the diverse imaging methods available, from the discovery of x-rays by Röntgen in 1895 to the recent techniques of magnetic resonance and positron emission tomography. The authors endeavour to point out the strengths and weaknesses of each method, using clinical examples where appropriate. Finally, future developments are discussed. It is hoped that this review will aid clinicians diagnosing and treating cancer patients to choose the most suitable imaging method for their patients from among the vast array available.

Diagnostic Imaging↗

PubMed1987

It is wise to prescribe NSAIDs with modern gastroprotective agents?

The administration of non-steroidal anti-inflammatory drugs (NSAIDs) leads to mucosal lesions in the upper gastrointestinal tract. Furthermore, NSAIDs increase the risk of ulcer bleeding and perforation, but the overall risk of fatal complications is relatively small (about 21 per one million prescriptions). Therefore, in asymptomatic patients, it is not justified to prescribe NSAIDs together with gastroprotective agents. The following recommendations can be given with respect to the management of peptic lesions in patients taking NSAIDs: (i) Fibre endoscopy should be performed even when there are relatively mild symptoms since mucosal lesions in rheumatic patients under NSAIDs produce minor or no symptoms. (ii) "Modern" NSAIDs might produce less gastric lesions than aspirin. (iii) Rheumatic patients with peptic disorders should be treated with an H2-antagonist. (iv) After complications such as ulcer bleeding or after rapid recurrence of peptic lesions, maintenance treatment with an H2-antagonist is advisable.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1981

Indigenous substitutes for modern prostheses and orthoses.

In most developing countries, the physically handicapped often have rehabilitation setbacks such as unavailability of modern rehabilitative aids which may result in non-achievement of the desired goals in activities of daily living. Children with poliomyelitis, hemiplegics, amputees and paraplegics top the list of patients requiring rehabilitation at University College Hospital, Ibadan. The amputees depend on wooden peg legs or pylons made by the occupational therapy department since modular and P.T.B. prostheses are presently not available in this hospital. Physiotherapists, therefore, encounter problems in teaching correct patterns of walking and other functional activities to the above-knee amputee because knee joints are absent. Rural amputee farmers use pylons as they can wade through water and mud with them. Calipers, toe raising devices, knee cages and spinal supports are required by 75% of the 300 children with poliomyelitis and some of the paraplegics receiving physiotherapy in this hospital. Due to lack of imported parts, materials and experienced personnel, it has not been possible to meet the required demands. The occupational therapy department, as well as indigenous shoe markers and iron welders, rescue the situation as much as possible. Similarly, cervical collars are made from PVC buckets. It is therefore necessary that research on the use of local materials for prostheses and orthoses be carried out. Difficulties encountered with imported parts and materials will be removed to the advantage of patients.

Artificial Limbs↗

PubMed1991

Ethical considerations in modern human experimentation.

The use of properly controlled clinical trials in medical experimentation has been of vital importance to the progress of medical science. At the same time, the new form of experimentation has also generated some of our most difficult and perplexing moral dilemmas. The solutions to the many complicated ethical problems involved in human experimentation are not straightforward, and despite numerous books, articles, codes, guidelines, and declarations, many specific issues of right and wrong in human experimentation have not yet been definitively resolved. Society today has an obligation greater than ever to control, regulate, and enforce properly balanced codes of human experimentation in order to minimize the unacceptable ethical problems and maximize the desired results of modern human experimentation. These, however, are not sufficient. The patient's greatest safeguard in experimentation is a skillful, intelligent, and conscientious physician and investigator. Thus, the investigator bears great responsibility in balancing between the common good and the individual's rights. In this article the relevant secular and Jewish ethical principles and rules concerning human experimentation are specified and methodologically organized. Particular emphasis is placed on the elucidation and evaluation of the ethical controversies surrounding randomized clinical trials.

Beneficence↗