Follow-up of American Cancer Society Special Postdoctoral Research Fellowship recipients.
A follow-up study of the 44 recipients of American Cancer Society, Inc., Special Postdoctoral Research Fellowship from 1962 to 1973 revealed that 11 of 21 M.D. candidates obtained their second (Ph.D.) degree at the end of training. By contrast, all but one among the 23 Ph.D. candidates were awarded the second (M.D.) degree. A great majority of either group remain in active research, regardless of whether or not they obtained the second degree. A very high percentage of their research is cancer related. (+info)
Quality of primary outpatient services in Dar-es-Salaam: a comparison of government and voluntary providers.
This study aimed to test whether voluntary agencies provide care of better quality than that provided by government with respect to primary curative outpatient services in Dar-es-Salaam. All non-government primary services were included, and government primary facilities were randomly sampled within the three districts of the city. Details of consultations were recorded and assessed by a panel who classed consultations as adequate, inadequate but serious consequences unlikely, and consultations where deficiencies in the care could have serious consequences. Interpersonal conduct was assessed and exit interviews were conducted. The study found that government registers of non-government 'voluntary' providers actually contained a high proportion of for-profit private providers. Comparisons between facilities showed that care was better overall at voluntary providers, but that there was a high level of inadequate care at both government and non-government providers. (+info)
The adaptability of the health promoting schools concept: a case study from Australia.
The adoption of the concept of the health promoting school internationally indicates that it is a timely and flexible concept that can be utilized by different countries to accommodate their particular contexts. Political, economic and socio-cultural factors are powerful forces that shape the construction of health promoting schools globally. How some of these factors operate will be exemplified through a description of the health promoting school movement in Australia with commonalities and variations with activities in member countries of the European Network of Health Promoting Schools highlighted. The unique role globally of the Australian Health Promoting Schools Association, as a non-government organization specifically established to promote the concept of the health promoting school, is described. Its contribution is as a neutral body representing diverse interests that can advocate in different settings and at all levels of influence. Additionally it provides a mechanism for networking, awareness raising and information exchange. The structure of the health and education sectors in Australia has shaped the conceptualization of a health promoting school, one that accommodates the country's specific context. Barriers, facilitating factors and challenges that exist for future work in the area are described. (+info)
Mental health care in Cambodia.
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization. (+info)
Multicenter randomized trial of a comprehensive prepared meal program in type 2 diabetes.
OBJECTIVE: To evaluate the clinical effects of a comprehensive prepackaged meal plan, incorporating the overall dietary guidelines of the American Diabetes Association and other national health organizations, relative to those of a self-selected diet based on exchange lists in free-living individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 202 women and men (BMI < or = 42 kg/m2) whose diabetes was treated with diet alone or an oral hypoglycemic agent were enrolled at 10 medical centers. After a 4-week baseline period, participants were randomized to a nutrient-fortified prepared meal plan or a self-selected exchange-list diet for 10 weeks. On a caloric basis, both interventions were designed to provide 55-60% carbohydrate, 20-30% fat, and 15-20% protein. At intervals, 3-day food records were completed, and body weight, glycemic control, plasma lipids, and blood pressure were assessed. RESULTS: Food records showed that multiple nutritional improvements were achieved with both diet plans. There were significant overall reductions in body weight and BMI, fasting plasma glucose and serum insulin, fructosamine, HbA1c, total and LDL cholesterol, and blood pressure (P < 0.001 or better for all). In general, differences in major end points between the diet plans were not statistically significant. CONCLUSIONS: Glycemic control and cardiovascular risk factors improve in individuals with type 2 diabetes who consume diets in accordance with the American Diabetes Association guidelines. The prepared meal program was as clinically effective as the exchange-list diet. The prepared meal plan has the additional advantages of being easily prescribed and eliminating the complexities of meeting the multiple dietary recommendations for type 2 diabetes management. (+info)
Implications of new diagnostic criteria for abnormal glucose homeostasis in women with previous gestational diabetes.
OBJECTIVE: To determine the consequences of applying revised American Diabetes Association (ADA) (1997) and World Health Organization (WHO) (1998) recommendations for the classification of glucose intolerance in women with previous gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: There were 192 women with previous GDM who took an oral glucose tolerance test (OGTT) 1-86 months after delivery and were classified by WHO (1985), ADA (1997, fasting glucose), and revised WHO (1998) guidelines. RESULTS: Among the 165 women without a preexisting diagnosis of diabetes, WHO-1985 and ADA-1997 provided similar estimates of diabetes prevalence (13.3% vs. 11.5%) but widely differing estimates of impaired glucose homeostasis (31.5% impaired glucose tolerance [IGT] by WHO-1985 vs. 10.9% impaired fasting glucose by ADA-1997 criteria). Overall, 56 women (34%) showed a classification discrepancy between WHO-1985 and ADA-1997 criteria, including 44 with normal fasting glucose by ADA-1997 criteria, but abnormal 2-h glucose by WHO-1985 criteria (40 IGT, 4 diabetes). The cardiovascular risk profile of these women was more favorable than that of 18 women with impaired fasting glucose. WHO-1998 recommendations reproduced ADA-1997 findings when used as a fasting screen, but behaved similarly to WHO-1985 criteria when 2-h glucose values were also analyzed. CONCLUSIONS: All criteria produced similar estimates of diabetes prevalence. However, analyses based on a single fasting glucose screen (and a threshold of 6.1 mmol/l) failed to identify 60% of women with abnormal 2-h glucose levels. Screening women with previous GDM (and by analogy, other groups at high risk of diabetes) with a single fasting glucose has low sensitivity for the detection of abnormal glucose tolerance. Recent guidelines recommending this approach require reevaluation. (+info)
Design and implementation of a training programme for general practitioners in emergency surgery and obstetrics in precarious situations in Ethiopia.
Medecins Sans Frontieres (MSF) has been implementing medical assistance programs in Ethiopia since 1994, including the rehabilitation of health structures and the supply of drugs and medical equipment. In 1995, the serious shortage of surgeons in Ethiopia prompted MSF to add a programme to train general practitioners to perform surgery in the Woldya region. The results of the relevant feasibility study were encouraging. The programme's design is based on recent educational data and MSF's experience with introducing transcultural training in countries where unstable conditions prevail. The training programme is currently being studied by the Ethiopian Health Ministry for use as a model for training general practitioners in surgery throughout the country. (+info)
A randomised controlled trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector.
OBJECTIVES: To compare outcome and resource utilisation among patients referred to the Amalthea Project, a liaison organisation that facilitates contact between voluntary organisations and patients in primary care, with patients receiving routine general practitioner care. DESIGN: Randomised controlled trial with follow up at one and four months. SETTING: 26 general practices in Avon. PARTICIPANTS: 161 patients identified by their general practitioner as having psychosocial problems. MAIN OUTCOME MEASURES: Primary outcomes were psychological wellbeing (assessed with the hospital anxiety and depression scale) and social support (assessed using the Duke-UNC functional social support questionnaire). Secondary outcomes were quality of life measures (the Dartmouth COOP/WONCA functional health assessment charts and the delighted-terrible faces scale), cost of contacts with the primary healthcare team and Amalthea Project, cost of prescribing in primary care, and cost of referrals to other agencies, over four months. RESULTS: The Amalthea group showed significantly greater improvements in anxiety (average difference between groups after adjustment for baseline -1.9, 95% confidence interval -3.0 to -0.7), other emotional feelings (average adjusted difference -0.5, -0.8 to -0.2), ability to carry out everyday activities (-0.5, -0.8 to -0.2), feelings about general health (-0.4, -0.7 to -0.1), and quality of life (-0.5, -0.9 to -0.1). No difference was detected in depression or perceived social support. The mean cost was significantly greater in the Amalthea arm than the general practitioner care arm ( pound153 v pound133, P=0. 025). CONCLUSION: Referral to the Amalthea Project and subsequent contact with the voluntary sector results in clinically important benefits compared with usual general practitioner care in managing psychosocial problems, but at a higher cost. (+info)