Program planning, evaluation, and the problem of alcoholism.
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Rational program planning and evaluation has been suggested as a necessary skill. First, a conceptual framework for planning and evaluation was presented and discussed, using the example of preventing alcoholism and providing services and rehabilitation for alcoholics. Second, a case study was presented, which is similar to that used by many professionals in their efforts to plan programs. Finally, some of the marked limitations of the case study were pointed out, when it was projected upon the conceptual framework. (+info)
The relationship of per capita gross national product to the prevalence of symptoms of asthma and other atopic diseases in children (ISAAC).
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BACKGROUND: Increasing prevalence and worldwide variation in asthma and other atopic diseases suggest the influence of environmental factors, at least one possibly related to socioeconomic wellbeing. This paper examines the relationship of symptoms of asthma, rhinitis and eczema with gross national product per capita (GNP per capita). METHODS: The prevalences of atopic symptoms in 6-7- and 13-14-year-old children were assessed in 91 centres (from 38 countries) and 155 centres (from 56 countries), respectively, in the International Study of Asthma and Allergy in Childhood (ISAAC). These symptoms were related to 1993 GNP per capita for each country as reported by the World Bank. The relationships between symptoms of atopic diseases and infant mortality, the human development index and 1982 GNP per capita were also considered. RESULTS: The countries in the lowest quartile of GNP per capita have the lowest median positive responses to all the questions on symptoms of asthma, rhinitis and eczema. There was a statistically significant positive association between wheeze in the last 12 months and GNP per capita in the 13-14-year age group, but not in the 6-7-year age group. There was also a positive association between GNP per capita and eczema in both age groups. CONCLUSIONS: The positive associations between GNP per capita and atopic symptoms being of only moderate strength suggests that the environmental factors are not just related to the wealth of the country. (+info)
Cultural issues and ethical dilemmas in palliative and end-of-life care in Spain.
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BACKGROUND: The concept of palliative care differs according to cultures and traditions. In Spain, palliative care programs have expanded in recent years. The European Commission Research Project in Palliative Care Ethics has sponsored ongoing research to analyze and clarify the conceptual differences in providing palliative care to patients in European countries with diverse cultures and backgrounds. METHODS: The authors present key ethical issues in clinical practice in palliative and end-of-life care in Spain and how these issues are influenced by Spanish culture. They discuss typical characteristics of the Spanish conceptual approach to palliative care, which might be relevant in an even larger Latin palliative care context. RESULTS: The cultural tradition in Spain influences attitudes toward euthanasia, sedation, the definition of terminality, care in the last 48 hours of life, diagnosis disclosure, and information. The overall care of terminally ill patients with an Hispanic background includes not only the treatment of disease, but also the recognition and respect of their traditions and culture. CONCLUSIONS: The Spanish palliative care movement has shifted its focus from starting new programs to consolidating and expanding the training of the professionals already working in the existing programs. Although there is a general consensus that a new philosophy of care is needed, the interpretation and application of this general philosophy are different in diverse sociocultural contexts. (+info)
Attitudes towards self-poisoning.
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Self-poisoning now constitutes one of the prime emergencies in hospital medical practice. This paper describes the results of the study of the attitudes of physicians and senior nurses towards several common illnesses in the medical wards. The junior doctors and the nurses who frequently have primary responsibility for the care of the self-poisoners tend to show unfavourable attitudes towards these patients. (+info)
Diabetes and social conditions in Estonia. A population-based study.
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BACKGROUND: The aim of this study was to investigate aspects of metabolic control, treatment and complications as well as quality of life in patients with diabetes mellitus from a defined population in Estonia. METHODS: We invited 220 randomly selected diabetes patients recruited to a clinical investigation from a local diabetes register of 1,100 patients in Viljandi, Estonia. The main outcome measures were derived from medical history, physical examination (height, weight and blood pressure), laboratory variables (blood glucose and glycated haemoglobin A1 (HbA1 normal reference range 3.2-5.6%), serum total and HDL cholesterol and creatinine), a questionnaire on disease-related knowledge and quality of life variables. RESULTS: In all, 181 diabetes patients were investigated, of whom 90% were diagnosed with type 2 diabetes. The mean diabetes duration was 8.9 years from clinical diagnosis and mean HbA1 level was 7.3%. The overall proportion of patients treated with insulin was 29.8% and with anti-hypertensive drugs 26.5%. Smoking was present in 14.3%. The proportion of patients with various diabetes complications was high (73.5%), mostly consisting of different manifestations of cardiovascular disease. Foot ulcers or gangrene were observed in 11.6%. A low level of quality of life was registered in many patients, mostly due to difficult living conditions. CONCLUSIONS: Diabetes patients in Viljandi showed an acceptable degree of glucose metabolic control, but reported a high degree of diabetes complications, as well as impaired quality of life. The diabetes complications may therefore be due to detrimental factors other than hyperglycaemia, e.g. the standard of care during previous years as well as current social and living conditions. (+info)
Air quality in postunification Erfurt, East Germany: associating changes in pollutant concentrations with changes in emissions.
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The unification of East and West Germany in 1990 resulted in sharp decreases in emissions of major air pollutants. This change in air quality has provided an opportunity for a natural experiment to evaluate the health impacts of air pollution. We evaluated airborne particle size distribution and gaseous co-pollutant data collected in Erfurt, Germany, throughout the 1990s and assessed the extent to which the observed changes are associated with changes in the two major emission sources: coal burning for power production and residential heating, and motor vehicles. Continuous data for sulfur dioxide, total suspended particulates (TSP), nitric oxide, carbon monoxide, and meteorologic parameters were available for 1990-1999, and size-selective particle number and mass concentration measurements were made during winters of 1991 and 1998. We used hourly profiles of pollutants and linear regression analyses, stratified by year, weekday/weekend, and hour, using NO and SO(2) as markers of traffic- and heating-related combustion sources, respectively, to study the patterns of various particle size fractions. Supplementary data on traffic and heating-related sources were gathered to support hypotheses linking these sources with observed changes in ambient air pollution levels. Substantially decreased (19-91%) concentrations were observed for all pollutants, with the exception of particles in the 0.01-0.03 microm size range (representing the smallest ultrafine particles that were measured). The number concentration for these particles increased by 115% between 1991 and 1998. The ratio of these ultrafine particles to TSP also increased by more than 500%, indicating a dramatic change in the size distribution of airborne particles. Analysis of hourly concentration patterns indicated that in 1991, concentrations of SO(2) and larger particle sizes were related to residential heating with coal. These peaks were no longer evident in 1998 due to decreases in coal consumption and consequent decreased emissions of SO(2) and larger particles. These decreases in coal combustion and the decreased concentrations of SO(2) and particles of larger size classes may have led to decreased particle scavenging and may be partially responsible for the observed increases in ultrafine particles. Traffic-related changes, such as increased numbers of trucks and increased use of diesel vehicles in Erfurt, were also associated with increased number concentrations of ultrafine particles. Morning particle peaks of all sizes were associated with NO and CO (markers for traffic) in both the 1991 and 1998 periods. There were significant differences in the ultrafine particle levels for morning hours between 1991 and 1998, suggesting that traffic was the cause of this increase. (+info)
Rheumatoid arthritis in an urban South African Negro population.
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(1) An epidemiological study of an urban South African Negro community has been carried out in Johannesburg. Altogether 964 respondents were examined and in each case radiographs of the hands and feet were obtained. Rheumatoid factor tests were carried out on 404 serum samples. (2) Rheumatoid arthritis (RA) was graded 'definite' or 'probable' on the basis of a modification of the Rome criteria (Kellgren, Jeffrey, and Ball, 1963a). (3) In marked contrast to the findings in rural Africans the prevalence of RA in this community was similar to that in Caucasian populations. Five respondents (all elderly women) had 'definite' RA, giving a prevalence of 1.4% of the females and 0.9% of the total population sample over 15 years old. The prevalence of 'definite' and 'probable' RA combined was 2.6% for males, 3.7% for females, and 3.3% for all individuals over 15 years old. Prevalence increased with age, reaching a maximum in the 65- to 74-year cohort. (4) The form and severity of the clinical and radiological features were unlike the mild manifestations seen in rural African peoples and closely resembled the usual clinical picture of rheumatoid disease. (5) The latex fixation test was positive in 12.1% of the sera tested, which is similar to the high titres found in other African populations. No obvious cause for this phenomenon was found. (6) Several reasons for the marked difference in prevalence of RA between this urban African population and a rural African population are considered. Marked intraracial differences such as this point to the importance of sociological and environmental factors in the pathogenesis of rheumatoid arthritis. (+info)
The Wessex Recent In-Patient Suicide Study, 1. Case-control study of 234 recently discharged psychiatric patient suicides.
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BACKGROUND: Psychiatric patients have a higher suicide risk following hospital discharge. AIMS: To identify social, clinical and health-care delivery factors in recently discharged patients. METHOD: Retrospective case-control study of 234 patients who died within 1 year of hospital discharge, matched for age, gender, diagnosis and admission period with 431 controls. Odds ratios for identified risk factors were calculated using conditional multiple logistic regression. RESULTS: Independent increased-risk factors were: not being White; living alone; history of deliberate self-harm (DSH); suicidal ideation precipitating admission; hopelessness; admission under different consultant; onset of relationship difficulties; loss of job; in-patient DSH; unplanned discharge; significant care professional leaving/on leave. Reduced-risk factors were: shared accommodation; delusions at admission; misuse of non-prescribed substances; and continuity of contact. CONCLUSIONS: Continuity of contact may reduce suicide risk. Discontinuity of care from a significant professional is associated with increased risk of suicide. (+info)