(1/869) Pediatric discharge against medical advice in Bouake Cote d'Ivoire, 1980-1992.
Discharge information was obtained from pediatric ward logbooks of the Centre Hospitalier Regional de Bouake from 1982 to 1992. While number of children admitted per month and discharge diagnosis remained relatively stable throughout the period, the proportion of children who left the hospital against medical advice increased by nearly 5 times during the 11-year period to over 12% of all pediatric admissions. The proportion of discharges against medical advice decreased to 10% of all pediatric admissions after institution of a programme to provide essential drugs at cost to patients (previously only available from private pharmacies). Most children who were taken from the hospital left within the first two days of hospitalization. The admission diagnoses of these children suggest that most had serious, life-threatening illness and that they left the hospital prior to having received adequate treatment. The increase in pediatric ward discharge against medical advice occurred simultaneously with serious budgetary shortfalls in the hospital resulting in inadequacy of medicines and basic equipment. Hospital staff suspected that most of the discharges against medical advice were caused by families being unable to afford the purchase of medicines and supplies necessary for inpatient treatment. It is suggested that widespread policies of decreasing funding for basic curative services in public hospitals may be associated with a substantial increase in preventable child mortality. (+info)
(2/869) Failure of acetylmethadol in treatment of narcotic addicts due to nonpharmacologic factors.
Acetylmethadol, a new narcotic substitute, has a longer duration of action than methadone. Seventeen subjects, former heroin users currently under methadone treatment, entered a study of the toxicity and efficacy of this drug. Only nine subjects completed the assessment phase of the study and began the acetylmethadol phase, and only one completed the 8-week study phase. Hence, no conclusions can be drawn about acetylmethadol's efficacy. The high attrition rate was unrelated to pharmacologic factors; the subjects were concerned that if this drug was effective there would be no methadone to take home and hence no opportunity to trade, sell or "play with" (that is, combine with other drugs) the latter. This study emphasizes the difficulty in determining the efficacy of specific drug treatments for opiate-dependent patients. (+info)
(3/869) A randomised controlled trial of specialist health visitor intervention for failure to thrive.
AIMS: To determine whether home intervention by a specialist health visitor affects the outcome of children with failure to thrive. METHODS: Children referred for failure to thrive were randomised to receive conventional care, or conventional care and additional specialist home visiting for 12 months. Outcomes measured were growth, diet, use of health care resources, and Bayley, HAD (hospital anxiety and depression), and behavioural scales. RESULTS: Eighty three children, aged 4-30 months, were enrolled, 42 received specialist health visitor intervention. Children in both groups showed good weight gain (mean (SD) increase in weight SD score for the specialist health visitor intervention group 0.59 (0.63) v 0.42 (0.62) for the control group). Children < 12 months in the intervention group showed a higher mean (SD) increase in weight SD score than the control group (0.82 (0.86) v 0.42 (0.79)). Both groups improved in developmental score and energy intake. No significant differences were found for the primary outcome measures, but controls had significantly more dietary referrals, social service involvement, and hospital admissions, and were less compliant with appointments. CONCLUSIONS: The study failed to show that specialist health visitor intervention conferred additional benefits for the child. However, the specialist health visitor did provide a more coordinated approach, with significant savings in terms of health service use. Problems inherent to health service research are discussed. (+info)
(4/869) Walking training for intermittent claudication in diabetes.
OBJECTIVE: Walking training (WT) is an established treatment for patients with intermittent claudication (IC). Abnormalities specific to diabetes, such as a relative preponderance of distal lesions and the contribution of microcirculatory disease, might well influence the results of WT. We compared changes in walking distance during WT in diabetic patients with those in nondiabetic control subjects. RESEARCH DESIGN AND METHODS: In consecutive patients with limiting IC and proven peripheral vascular disease, 33 patients with diabetes were compared with 136 control subjects during a half-year supervised WT program. Walking parameters were determined every 2 months, while vascular parameters were obtained at the start and end of the program. RESULTS: Of the 33 diabetic patients, 25 (76%) completed the program, as did 87 of the 136 (64%) control subjects. Thereafter, the symptom-free walking distance and the maximum walking distance (MWD) were significantly increased in diabetic patients from 142 +/- 30 to 339 +/- 57 m and from 266 +/- 39 to 603 +/- 52 m, respectively, and in control subjects from 126 +/- 8 to 400 +/- 39 m and from 292 +/- 18 to 628 +/- 36 m, respectively. The relative gain in MWD was 88% greater in those with diabetes. The vascular parameters were comparable for both groups before and after WT. CONCLUSIONS: WT is an effective treatment for IC, with a greater relative gain in diabetic patients. (+info)
(5/869) Risk factors for neck and upper limb disorders: results from 24 years of follow up.
OBJECTIVES: To investigate associations between different potential risk factors, related and not related to work, and disorders of the neck and upper extremities occurring up to 24 years later. METHODS: The study comprised 252 women and 232 men, Swedish citizens, 42-59 years of age and in a broad range of occupations. Information about potential risk factors was available from a former study conducted in 1969. Data on disorders of the neck, shoulder, and hand-wrist disorders were obtained retrospectively for the period 1970-93. RESULTS: Risk factors were found to differ between the sexes. Among women over-time work, high mental workload, and unsatisfactory leisure time were associated with disorders in the neck-shoulder region. Interaction was found between high mental workload and unsatisfactory leisure time. Neck symptoms earlier in life were associated with recurrent disorders. Hand and wrist disorders were associated mainly with physical demands at work. Among men blue collar work and a simultaneous presence of high mental workload and additional domestic workload predicted disorders in the neck-shoulder region. CONCLUSIONS: Factors related and not related to work were associated with disorders of the neck, shoulders, and hands and wrist up to 24 years later in life. These included factors related to working hours which previously have not been noted in this context. Interactions between risk factors both related and not related to work were commonly found. (+info)
(6/869) Long term effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a meta-analysis.
BACKGROUND: The role of inhaled corticosteroids in the long term management of chronic obstructive pulmonary disease (COPD) is still unclear. A meta-analysis of the original data sets of the randomised controlled trials published thus far was therefore performed. The main question was: "Are inhaled corticosteroids able to slow down the decline in lung function (FEV1) in COPD?" METHODS: A Medline search of papers published between 1983 and 1996 was performed and three studies were selected, two of which were published in full and one in abstract form. Patients with "asthmatic features" were excluded from the original data. Ninety five of the original 140 patients treated with inhaled corticosteroids (81 with 1500 micrograms beclomethasone daily, six with 1600 micrograms budesonide daily, and eight with 800 micrograms beclomethasone daily) and 88 patients treated with placebo (of the initial 144 patients) were included in the analysis. The effect on FEV1 was assessed by a multiple repeated measurement technique in which points of time in the study and treatment effects (inhaled corticosteroids compared with placebo) were investigated. RESULTS: No baseline differences were observed (mean age 61 years, mean FEV1 45% predicted). The estimated two year difference in prebronchodilator FEV1 was +0.034 l/year (95% confidence interval (CI) 0.005 to 0.063) in the inhaled corticosteroid group compared with placebo. The postbronchodilator FEV1 showed a difference of +0.039 l/year (95% CI -0.006 to 0.084). No beneficial effect was observed on the exacerbation rate. Worsening of the disease was the reason for drop out in four patients in the treatment group compared with nine in the placebo group. In the treatment group six of the 95 subjects dropped out because of an adverse effect which may have been related to the treatment compared with two of the 88 patients in the placebo group. CONCLUSIONS: This meta-analysis in patients with clearly defined moderately severe COPD showed a beneficial course of FEV1 during two years of treatment with relatively high daily dosages of inhaled corticosteroids. (+info)
(7/869) True status of smear-positive pulmonary tuberculosis defaulters in Malawi.
The article reports the results of a study to determine the true outcome of 8 months of treatment received by smear-positive pulmonary tuberculosis (PTB) patients who had been registered as defaulters in the Queen Elizabeth Central Hospital (QECH) and Mlambe Mission Hospital (MMH), Blantyre, Malawi. The treatment outcomes were documented from the tuberculosis registers of all patients registered between 1 October 1994 and 30 September 1995. The true treatment outcome for patients who had been registered as defaulters was determined by making personal inquiries at the treatment units and the residences of patients or relatives and, in a few cases, by writing to the appropriate postal address. Interviews were carried out with patients who had defaulted and were still alive and with matched, fully compliant PTB patients who had successfully completed the treatment to determine the factors associated with defaulter status. Of the 1099 patients, 126 (11.5%) had been registered as defaulters, and the true treatment outcome was determined for 101 (80%) of the latter; only 22 were true defaulters, 31 had completed the treatment, 31 had died during the treatment period, and 17 had left the area. A total of 8 of the 22 true defaulters were still alive and were compared with the compliant patients. Two significant characteristics were associated with the defaulters; they were unmarried; and they did not know the correct duration of antituberculosis treatment. Many of the smear-positive tuberculosis patients who had been registered as defaulters in the Blantyre district were found to have different treatment outcomes, without defaulting. The quality of reporting in the health facilities must therefore be improved in order to exclude individuals who are not true defaulters. (+info)
(8/869) Depressive symptoms and occurrence of type 2 diabetes among Japanese men.
OBJECTIVE: To examine the relationship between depressive symptoms and the incidence of type 2 diabetes. RESEARCH DESIGN AND METHODS: In 1984, 2,764 male employees of an electrical company in Japan completed a self-administered questionnaire including the Zung Self-Rating Depression Scale (SDS). They were followed for the next 8 years, and 2,380 (86%) responded to the follow-up survey in 1992. During the follow-up survey, occurrence of type 2 diabetes was diagnosed according to World Health Organization criteria. RESULTS: A total of 41 cases of type 2 diabetes were identified during the 8-year follow-up survey. After controlling for other known risk factors for type 2 diabetes, a proportional hazard analysis indicated that subjects who had moderate or severe levels of depressive symptoms (> or = 48 on the SDS) at baseline had a 2.3 times higher risk of having type 2 diabetes at the follow-up survey than those who were not depressed (< or = 39 on the SDS) (P < 0.05). CONCLUSIONS: Depressive symptoms may be associated with the onset of type 2 diabetes. (+info)