The Finnish National Programme for Chronic Bronchitis and Chronic Obstructive Pulmonary Disease (COPD) 1998-2007 was set up to reduce the prevalence of COPD, improve COPD diagnosis and care, reduce the number of moderate to severe cases of the disease, and reduce hospitalisations and treatment costs due to COPD. Over 900 events for 25,000 participating healthcare workers were arranged. The major strengths of this programme included multidisciplinary strategies and web-based guidelines in nearly all primary health care centres around the country.
Data from national registries, epidemiological studies and questionnaires were used to measure whether the goals had been reached.
The prevalence of COPD remained unchanged. Smoking decreased in males from 30% to 26% (p
Comment In: Prim Care Respir J. 2011 Jun;20(2):109-1021603847
The authors presented clinical and physiologic studies of cardiac and respiratory systems and peripheral circulation among workers having various professions at aluminium production in Kolsky North. Multiple functional study methods were used including tachooscillography, electrocardiography, rheovasography, rheoencephalography, thermovision. The results enabled to specify duration and character of health disorders caused by occupational environment.
With the aid of gaschromatographic techniques a fatty-acid composition was studied of lipids of the expired air condensate and sweat of patients in uncomplicated/complicated course of acute myocardial infarction versus morphological changes in the blood-air barrier. The complicated course of the condition vs uncomplicated one has been found out to be accompanied by a significant increase in the lipid content of the polyunsaturated fatty acids--linoleic and arachidonic acids--in the studied biological objects, which fact can be used in diagnosis and prognostication of development of complications in the acute period of myocardial infarction.
UMR CNRS 6249 chrono-environnement, service de pneumologie, hôpital Jean-Minjoz, université de Franche-Comté, CHU de Besançon, 3 boulevard Alexandre-Fleming, Besançon cedex, France. email@example.com
The follow-up of workers occupationally exposed to asbestos has two possible beneficial effects: (1) individually, both medical by screening for diseases related to asbestos and social by notification of occupational disease and/or compensation from the indemnity funds for asbestos victims; (2) collectively, by the establishment of epidemiological surveillance (follow-up of cohorts) and evaluation of the impact of follow-up in terms of health benefits and compensation. The respiratory disorders related to asbestos are: cancer (malignant pleural mesothelioma and bronchial carcinoma), asbestos-related pulmonary fibrosis, and pleural disease (plaques, pleural fibrosis and benign pleurisy). In the light of the data currently available and the effectiveness of the tools used, medical and public health benefits of screening for mesothelioma have not been demonstrated. The early diagnosis of primary bronchial carcinoma can theoretically improve the prognosis of the subjects screened, particularly by identification of stage I disease on CT (pulmonary nodules). This is a common finding but there are a large number of false-positives. While we await the results of several international randomised trials, the benefits of a screening programme for bronchial carcinoma in the population at risk have not been demonstrated. There is no effective treatment for asbestosis but this is an independent risk factor for bronchial carcinoma and it is evidence of heavy asbestos exposure. Stopping smoking in subjects suffering from asbestosis will reduce the incidence of bronchial carcinoma. There is no effective treatment for asbestos-related benign pleural diseases but these are markers of exposure. The presence of pleural plaques has not been shown to be an aetiological factor for thoracic cancers. Post-occupational follow-up may involve risks to health, particularly repeated irradiation and invasive diagnostic procedures. It is also necessary to consider the psychological consequences inherent in all screening programmes. In conclusion, post-occupational follow-up might reduce the mortality of lung cancer by screening for localised disease and its incidence by a targeted anti-smoking programme. The theoretical benefits, that have not yet been demonstrated, have to be seen in perspective with the risks to physical and psychological health related to both screening and diagnostic procedures.
The aim of this work was to study the incidence, diagnostics and clinical features of interstitial lung diseases (ILD) in the practical work of pulmonological and rheumatological departments of a multifield hospital Theanalysis included 565 case histories of the patients admitted to these departments in 2008-2012. The structure of ILD was elucidated along with the frequency of major clinical symptoms ofsarcoidosis and rheumatic diseases, the occurrence of clinico-morphological variants of ILD. Difficulties encountered in diagnostics of ILD and systemic scleroderma as well as their causes are discussed Resultsof the 5 year followup of 40 patients are presented.
Analysis of the quality and modes of clinical diagnostics of protracted pneumonia in a tuberculosis clinic revealed the most frequent causes of this condition responsible for hyperdiagnostics of tuberculosis. These are concomitant diseases, pneumosclerosis, chronic bronchitis, fibrous transformation of the bronchial tree, complicated clinical course of pneumonia, age above 60 years, history of tuberculosis, inadequate or short-term antibiotic therapy at the initial stages of diagnostics. Motivational prerequisites for high-quality diagnostic work include compliance with standards and guidelines for the examination and management of patients suspected of having pneumonia with a view to detecting tuberculosis. Such approach would decrease the frequency of ungrounded hospitalization of patients at tuberculosis clinics.
The outpatient cards and case histories of 456 patients with tuberculosis detected in Samara in the period from January 1, 1999 to December 31, 2003 were examined. Tuberculosis was identified in 58.3% of the patients when they were asking for medical aid; among them 54.2% were treated at general hospital where caseous pneumonia, disseminated tuberculosis, and tuberculous pleurisy were more frequently diagnosed. The unemployed able-bodied persons amounted to 43% of the detected patients with tuberculosis, of whom 81% being identified on recourse to a doctor. Primary drug resistance does not depend on the procedure of tuberculosis detection. Early detection and the initiation of treatment will improve a clinical prognosis in patients with new-onset tuberculosis.
The article deals with the comprehensive expertise of quality of diagnostics of bronchial asthma in ambulatory polyclinic institutions of pediatric profile. The following techniques were applied: the retrospective analysis of all cases of bronchial asthma among children of City of Yugorsk of Hanti-Mansiisky autonomous okrug (n = 92), expertise of the causes of late diagnostics and possible ways of optimization of earlier diagnostics of bronchial asthma in ambulatory polyclinic institution (20 experts), testing the pediatricians working in children polyclinics (n = 95) on the knowledge of dealing with bronchial asthma. The late diagnostics is ascertained in 95% of cases and average period of diagnostics delay consisted 3 days. The leading role of inadequate theoretical background of pediatricians as a "triggering device" in progressive development of disease is established. The necessity to develop various forms of ongoing training of physicians of primary care for optimizing modern diagnostics of bronchial asthma in polyclinic conditions is justified.