To describe and analyse 75-year-old persons' health conditions and how they were associated with socio-demographic status and sense of coherence to produce a knowledge base for district nurse's preventive home visits.
Action plans are needed to promote health and to prevent diseases amongst older people. One action plan is preventive home visits to 75-year-old persons by the district nurse. Though the district nurse has a broad knowledge in the field of preventive health work, preventive home visits to 75-year-old persons was a new responsibility. Although aging and older persons health have been investigated in many varied studies, it was difficult to find a comprehensive view, in general and from a district nursing perspective, of 75-year olds' health conditions.
Cross-sectional.
In total 583, 75-year-olds (74%) answered a questionnaire regarding health and well-being, health problems, health behaviour and sense of coherence.
Most 75-year-old persons reported their health as good or very good, but they also reported health problems such as: pain, sleeping problems, memory failure, fatigue, poor understanding of their own health and illnesses, problems with elimination patterns and underweight and overweight. 75-year-old persons living alone, those with elementary school education and women reported worse health and well-being than other groups.
This study contributes to the knowledge about health issues that concern persons of 75 years of age. It gives a suggestion as to what the district nurses should be aware of when performing preventive home visits.
This study raises the importance of preventive health work regarding 75-year-old persons. It suggests how to educate district nurses in how to perform preventive home visits to older persons.
A category of patients with tuberculosis concomitant with HIV infection, who were admitted for inpatient care to the infection department of Tuberculosis Clinical Hospital No. 7, Moscow, during 1996-2001, was analyzed. Peculiarities of the mentioned patients' category (205 subjects) were studied at the anti-TB facility. It was established that males (83.4%), aged 21-30 (48.9%), as well as unemployed (71%) prevailed. As much as 14% of them were homeless and 33% had a prison history. Drug-addiction (76%) and hepatitis C and B (77%) were found to be the key concomitant pathologies in them. HIV was primarily diagnosed at the anti-TB facility in 52% of patients, while tuberculosis had set on before HIV in 34.8% of patients. A major part of patients with tuberculosis concomitant with HIV, who were at the anti-TB facility, had early HIV stages. Specific features of the clinical course of tuberculosis were defined for patients with early HIV stages. It was established that tuberculosis concomitant with early HIV stages is deprived of any peculiarities except for the primary signs' stage, if it has the form of an acute infection. An exacerbation of the tuberculosis process, which quite often leads to its generalization and fatal outcome, can happen during the mentioned period due to a pronounced immunodeficiency.
Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, 624 North Broadway, Room 447, Baltimore, MD 21205, USA. llebrun@jhsph.edu
To conduct cross-country comparisons and assess the effect of foreign birth on access to primary and preventive care in Canada and the United States.
Secondary data from the 2002 to 2003 Joint Canada-United States Survey of Health.
Descriptive and comparative analyses were conducted, and logistic regression models were used to assess the effect of immigrant status and country of residence on access to care. Outcomes included measures of health care systems and processes, utilization, and patient perceptions.
In adjusted analyses, immigrants in Canada fared worse than nonimmigrants regarding having timely Pap tests; in the United States, immigrants fared worse for having a regular doctor and an annual consultation with a health professional. Immigrants in Canada had better access to care than immigrants in the United States; most of these differences were explained by differences in socioeconomic status and insurance coverage across the two countries. However, U.S. immigrants were more likely to have timely Pap tests than Canadian immigrants, even after adjusting for potential confounders.
In both countries, foreign-born populations had worse access to care than their native-born counterparts for some indicators but not others. However, few differences in access to care were found when direct cross-country comparisons were made between immigrants in Canada versus the United States, after accounting for sociodemographic differences.
Notes
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We report findings from a multi-method study investigating drug injectors' access to needles and syringes in three large Russian cities (Moscow, Volgograd, Barnaul).
We undertook 209 qualitative interviews among drug injectors, and supplemented these with baseline data from a community-recruited survey of 1473 drug injectors.
Almost all (93%; 1277) injectors used pharmacies as their main source of clean injecting equipment, and only 7% (105) reported ever having had contact with city syringe exchange projects. Good access to syringes has coincided with the expansion of private pharmacies. Key factors contributing to pharmacy access included: geographic proximity; low cost; and the restrictive policies of exchange instituted at local syringe exchanges. A fear of police interference surrounded the use of pharmacies and syringe exchanges, and fed a reluctance to carry used needles and syringes, which in turn acted as a disincentive to syringe exchange attendance. The perceived benefits of syringe exchanges over pharmacies included the additional health services on offer and the social support provided, but these benefits were over-shadowed by disadvantages. Multivariable analyses of survey data in two cities show no differences on account of risk behaviour among injectors sourcing equipment from pharmacies compared to syringe exchanges.
HIV prevention coverage indicators need to include measures of pharmacy-based syringe distribution and not only measures of syringe exchange coverage. There is an urgent need to pilot pharmacy-based distribution and exchange projects in Russia as well as other forms of secondary syringe distribution. Alongside expanding the reach of dedicated syringe exchange projects, pharmacy-based syringe distribution, and exchange, may help improve coverage of cost effective HIV prevention measures targeting drug injectors.
The incidence of acute epiglottitis in children is declining in the province of Quebec, Canada. In 1988, a PRP-D anti-Haemophilus type B vaccine was introduced into the routine vaccination schedule of 18-month-old children. A substantial reduction in the occurrence of acute epiglottitis was perceived by clinicians. Since 1992, improved new vaccines (PRP-T, HbOC, PRP-OMPC), given to 2-month-old infants, have been expected to increase the efficacy of the immunization program. The impact of the immunization program on preventing acute epiglottitis was verified using a provincial database system called Med-Echo. In the presumably vaccinated target population (0 to 6 years old), 15 children suffered acute epiglottitis in 1993, whereas 97 cases were reported on the average for each yearly period from 1984 to 1987, just before the program's inception. Thus, the incidence of acute epiglottitis in preschoolers was reduced to 15.4% of its former level. The overall efficacy of the immunization program in preventing acute epiglottitis, therefore, is estimated to be 84.6%.
Addiction Research Centres and the Nurturing of Creativity. Substance abuse research in a modern health care centre: the case of the Centre for Addiction and Mental Health.
The Centre for Addiction and Mental Health is one of the premier centres for research related to substance use and addiction. This research began more than 50 years ago with the Addiction Research Foundation (ARF), an organization that contributed significantly to knowledge about the aetiology, treatment and prevention of substance use, addiction and related harm. After the merger of the ARF with three other institutions in 1998, research on substance use continued, with an additional focus on comorbid substance use and other mental health disorders. In the present paper, we describe the structure of funding and organization and selected current foci of research. We argue for the continuation of this successful model of integrating basic, epidemiological, clinical, health service and prevention research under the roof of a health centre.
Many of the world's life threatening diseases (e.g. cancer, heart disease, stroke) could be prevented by eliminating life-style habits such as tobacco use, unhealthy diet, physical inactivity and excessive alcohol use. Incorporating evidence-based research on methods to change unhealthy lifestyle habits in clinical practice would be equally valuable. However gaps between guideline development and implementation are well documented, with implications for health care quality, safety and effectiveness. The development phase of guidelines has been shown to be important both for the quality in guideline content and for the success of implementation. There are, however, indications that guidelines related to general disease prevention methods encounter specific barriers compared to guidelines that are diagnosis-specific. In 2011 the Swedish National board for Health and Welfare launched guidelines with a preventive scope. The aim of this study was to investigate how implementation challenges were addressed during the development process of these disease preventive guidelines.
Seven semi-structured interviews were conducted with members of the guideline development management group. Archival data detailing the guideline development process were also collected and used in the analysis. Qualitative data were analysed using content analysis as the analytical framework.
The study identified several strategies and approaches that were used to address implementation challenges during guideline development. Four themes emerged from the analysis: broad agreements and consensus about scope and purpose; a formalized and structured development procedure; systematic and active involvement of stakeholders; and openness and transparency in the specific guideline development procedure. Additional factors concerning the scope of prevention and the work environment of guideline developers were perceived to influence the possibilities to address implementation issues.
This case study provides examples of how guideline developers perceive and approach the issue of implementation during the development and early launch of prevention guidelines. Models for guideline development could benefit from an initial assessment of how the guideline topic, its target context and stakeholders will affect the upcoming implementation.
