Stroke is amenable to the entire spectrum of health services, ranging from prevention of its risk factors, to the treatment of acute stroke and rehabilitation and palliation of stroke. The aim of this study was to determine the number of persons with the capacity to benefit from evidence-based effective stroke services. Population-based survey and registry data along with published, evidence-based recommendations for services were used to determine the number of persons in Eastern Ontario with stroke (including risk factors, acute stroke and chronic stroke) and their related need for services (including prevention programs, diagnostic services, treatment of acute stroke and rehabilitation). These estimates were then compared to the actual provision of these services. Estimates of the need for effective services exceeded the provision of all services with the exception of pharmacologic treatment for diabetes mellitus and carotid endarterectomy for acute stroke. The approach was able to identify both the under-provision and over-provision of evidence-based effective services for stroke. This study has shown that an epidemiologically-based needs assessment could be a useful basis for the planning of health services.
The reliability of a statistical mortality rate due to pulmonary tuberculosis was analyzed in 10 Russian Federation's subjects having the least rates. It was shown that its reliability might be objectively assessed by a method for complex analysis of the rates reflecting the population coverage of prophylactic examinations, the proportion of tuberculosis patients identified at their visits to health care facilities, and the pattern of patients with new-onset pulmonary tuberculosis. The reliability of this rate is mainly influ-enced by the prophylactic examination coverage of the population at increased risk for tuberculosis. Underidentification of patients with pulmonary tuberculosis leads to a discrepancy in the actual and statistical deaths from pulmonary tuberculosis with its underestimated values.
In market conditions, population health becomes a pawn of peoples social and vital status. Attitude towards health is vital need of every individual and public strategic target. Both physicians opinions on health values and level of their knowledge in the field of preventive medicine were studied using specially elaborated questionnaire. In physicians views on forms of preventive activities and their effectiveness differences were established depending on various resource support of workplace. Development of health values in society becomes actual target and training of highly professional personnel in the area of preventive medicine can be one of its possible directions.
Despite the high prevalence of type 2 diabetes in some immigrant and refugee communities in Norway, there is very little information available on their utilization of diabetes prevention interventions, particularly for women from Somali immigrant communities. A qualitative study of 30 Somali immigrant women aged 25 years and over was carried out in the Oslo area. Unstructured interviews were used to explore women's knowledge of diabetes, their access to preventive health facilities, and factors impeding their reception of preventive health programs targeted for the prevention of type 2 diabetes. The study participants were found to have a good knowledge of diabetes. They knew that a sedentary lifestyle and unhealthy diet are among the risk factors for diabetes. Regardless of their knowledge, participants reported a sedentary lifestyle accompanied with the consumption of an unhealthy diet. This was attributed to a lack of access to tailored physical activity services and poor access to health information. Considering gender-exclusive training facilities for Somali immigrant women and others with similar needs, in addition to access to tailored health information on diet, may encourage Somali women to adopt a healthy lifestyle, and it will definitely contribute to a national strategy for the prevention of diabetes.
To compare health care utilization between Canadian and U.S. residents.
Nationally representative 2007 surveys from the Medical Expenditure Panel Survey for the United States and the Canadian Community Health Survey for Canada.
We use descriptive and multivariate methods to examine differences in health care utilization rates for visits to medical providers, nurses, chiropractors, specialists, dentists, and overnight hospital stays, usual source of care, Pap smear tests, and mammograms.
The poor and less educated were more likely to utilize health care in Canada than in the United States. The differences were especially pronounced for having a usual source of care and for visits to providers, specialists, and dentists. Health care use for residents with high incomes and higher levels of education were not markedly different between the two countries and often higher for U.S residents. Foreign-born residents were more likely to use health care in Canada than in the United States. The descriptive results were confirmed in multivariate regressions.
Given the magnitude of our results, the health insurance structure in Canada might have played an important role in improving access to care for subpopulations examined in this study.
Surgical treatment of carotid stenosis after the onset of ischaemic symptoms should be performed within 2 weeks. This aim was accomplished only in 11% during the years 2007-2008 in the Helsinki University Central Hospital (HUCH) region. Since then, special efforts have been made in order to shorten the delay. The aim of this study was to find out how these changes affected the symptom-to-knife time (SKT).
All symptomatic patients (n = 144) who had carotid endarterectomy (CEA, n = 145) in HUCH in 2010 were retrospectively analysed and the SKT was determined.
Of the operations, 37% (n = 53) were performed within the recommended 2 weeks. The median SKT was 19 days (1-183). Of the patients who came to HUCH on an emergency basis (n = 80), 55% (n = 45) were operated within 2 weeks and their median SKT was 13 days (1-148).
The changes that were made in 2008-2009 have significantly shortened the delay in the treatment of carotid stenosis, but the desired time frame of 2 weeks was reached far too seldom. The greatest benefit from preventive CEA is achieved when patients are referred emergently to a clinic where neurologist, imaging resources and vascular surgeon are available.
We conducted a survey of 518 patients who had been admitted to three hospitals for selected medical, surgical, and obstetrical conditions. All patients came from the same city. One of the hospitals had put forward health promotion and disease prevention as a formal goal. Almost 40% of the respondents reported that they received health counseling during their hospital stay. Logistic regression analyses revealed that medical care processes and organizational factors were more important than patient characteristics in determining health counseling. The only patient characteristic that was positively related to health counseling was "perceived poor health status." Favorable conditions for the development of health counseling included having an attending physician different from the one who treated the patient before entering the hospital, an adequate number of physician visits, and a longer length of stay. Being admitted to a medical ward rather than a surgical or an obstetrical ward also was associated with more frequent health counseling. No significant differences were found among hospitals. Finally, having a general practitioner rather than a specialist as attending physician did not make a difference. These findings support the view that although hospitals have an important and legitimate role to play in health promotion, organizational and institutional obstacles to implementing such practices must not be ignored.
To examine rates of influenza vaccination, mammography, and Papanicolaou smear by comparing data obtained from the Ontario Health Insurance Plan administrative database with rates as self-reported in the Canadian Community Health Survey.
Retrospective cohort study using data from Statistics Canada's 2000-2001 Canadian Community Health Survey and from the Ontario Health Insurance Plan administrative database for the same period.
Those aged 12 and older who had received influenza vaccination, women aged 35 or older who had had mammograms within the past 2 years, and women aged 18 or older who had had Pap smears within the past 3 years who were surveyed during the Canadian Community Health Survey in 2001.
Rates of influenza vaccination, mammography, and Pap smear in Ontario's 14 Local Health Integration Networks by network, age group, and socioeconomic status.
Rates varied by health network. Analysis by age showed that influenza vaccination rates increased with age and peaked among those 75 and older. Rates of mammography screening increased with age but dropped substantially among those 75 and older. Rates of Pap smear peaked among those 20 to 39 and decreased with increasing age. Rates of mammography and Pap smear increased with rising socioeconomic status, but influenza vaccination rates did not differ substantially by socioeconomic status. Rates for all 3 preventive maneuvers were lower in the Ontario Health Insurance Plan data than in the self-reported Canadian Community Health Survey data.
There are obstacles to finding out the true rates of preventive health care use in Ontario. We need to ascertain these rates in order to establish a criterion standard for delivery of these services. Development of programs to target specific geographic locations, socioeconomic classes, and high-risk groups are needed to increase the overall use of preventive health services in Ontario.
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Screening and early diagnosis has been shown to reduce the morbidity and mortality associated with certain conditions such as cervical cancer. The role of general practitioners in promoting primary prevention of diseases is particularly important given that they have frequent contact with a large proportion of the population. This study assessed the extent to which general practitioners documented recommended preventive screening interventions among eligible patients.
We used a retrospective chart audit to assess patient visits to primary care clinics in Calgary, Canada from 2002-2004. We included fee for service physicians who practiced > or = 2 days per week at their current location and excluded those whose primary practice was at walk-in clinics, community health centers, hospitals or emergency rooms. We included charts of patients who during the study period were age 35 years or older and had at least 2 visits to a clinic. We randomly selected and reviewed charts (N = 600) from 12 primary care clinics and abstracted information on 6 conditions recommended for preventive screening. Opportunities for preventive screening were determined based on recommendations of the Canadian Task Force on Preventive Health Care, the American College of Physicians, and the Canadian Cancer Society. Our main outcome measures included cancer screening (mammography and pap smears), immunization (influenza and pneumococcal), and risk factor assessment (cholesterol measurement and smoking cessation consultation).
Patient visits to GP clinics present opportunities for preventive screening. However, we found that documentation of interventions was low, ranging from 40.3% (cholesterol measurement) to 0.9% (pneumococcal vaccination) within 1 year, and from 67.4% to 1.8% within the prior 3 years.
Documentation of preventive screening interventions by general practitioners was relatively low compared to the number of patients eligible for preventive screening. Some physicians opt to screen for PSA and DRE which is not recommended by the Canadian Task Force on Preventive HealthCare.
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