Transgene expression kinetics after transfection with cationic phosphonolipids in hematopoietic non adherent cells

Persons with chronic mental illnesses have a higher prevalence of medical illnesses and higher mortality rates than the general population. Those living in the community are usually linked with mental health services but are expected to manage their own medical care. The ability to manage their health care and the ability of "surrogate families" to assist them were measured among residents and staff of supervised community residences. In its surrogate role, the agency promoted routine health examinations and follow-up care. Its staff was a central resource for the residents, who sought out staff members for assistance with their health problems. However, residents and staff alike lack knowledge about health problems, medications, and approaches to modifying unhealthy lifestyle practices. Although residents identified lack of knowledge about sexually transmitted diseases as a major concern, staff indicated discomfort with this topic. These findings suggest the importance of supporting chronically mentally ill persons and residential staff in managing residents' health care functions.     

The health and welfare system for elderly in France

Dichotomy is the main characteristic of the Health and Welfare system in France. This system lies on two distinct fields, the medical field which is managed by the National Government, and the social field managed by the Local Government. The French home care policy for the elderly has developed a large number of services to assist in activities of daily living, to provide nursing and medical care at home, to improve living conditions, to maintain social relationships, and to postpone institutionalization and hospitalization, respectively. The main home care service is represented by "home helpers" who provide maid Notiniralics services. The second widely used service is the "home care service" performed by a team of nurses, assistant-nurses, psychologists, physiotherapists. This team provides nursing care and assistance in activities of daily living. As for institutions for the elderly, they are divided into welfare and medical institutions. The welfare institutions include social establishments like shelter homes and nursing homes. The medical institutions are mostly represented by long-term care hospitals. One of the main goals of the aging policy is to create medical wards in welfare institutions in response to the increased dependency of the institutionalized elderly. Recent experimental and innovative concepts have been established, such as "shelter homes for dependent elderly" for physically or cognitively impaired elderly.     

Catching patients: tuberculosis and detention in the 1990s

The resurgence of tuberculosis (TB) in the early 1990s, including multidrug-resistant strains, led health officials to recommend the use of involuntary detention for persistently nonadherent patients. Using a series of recently published articles on the subject, this paper offers some opinions on how detention programs have balanced protection of the public's health with patients' civil liberties. Detained persons are more likely than other TB patients to come from socially disadvantaged groups. Health departments have generally used coercion appropriately, detaining patients as a last resort and providing them with due process. Yet health officials still retain great authority to bypass "least restrictive alternatives" in certain cases and to detain noninfectious patients for months or years. Misbehavior within institutions may inappropriately be used as a marker of future nonadherence with medications. As rates of TB and attention to the disease again decline, forcible confinement of sick patients should be reserved for those persons who truly threaten the public's health.     

Background and prospects of the Community Health Act

Japan was defeated in World War II and almost all of the nation was demoralized by the destruction and damage to much of the nation. The medical and health care system during and before World War II needed to be reformed radically and fundamentally since almost all medical and health institutes were destroyed. On the other hand, many health personnel came back from overseas after the war. Japanese modern medicine had developed on the basis of German medicine; however, many aspects of American medicine, including public health and democracy, were rapidly introduced following the end of World War II. The American type of health center was established and many laws concerning medical and health care were enacted in 1947-1948. One of them was "The Health Center Law." The National Health Insurance Act was enacted in 1958 and the total population has been covered by health insurance plans since 1961. Many physicians quit the health centers and they have worked as clinicians under the National Health Insurance scheme, because health centers were introduced before adequate education and research existed in the field of public health. On the other hand, the health insurance scheme was in its golden age during the high economic growth period of the 1960s. Japan has succeeded in all forms of modern technology and economy for the past 30 years and is now one of the top nations in the field of medical and health care, such as the numbers of clinics and hospitals and beds, the frequency of consulting with a doctor, length of hospital stay, examinee rates in mass health examinations in the community and workplace and so on. Health conditions have changed drastically from the 1950s to the present. Therefore, health centers do not fit current health needs. For example, mortality from tuberculosis, acute infections diseases and also stomach and uterus cancers and apoplexy have decreased rapidly while mortality from chronic diseases, especially lung, breast and rectal cancers, and myocardial infarction have increased gradually. Changes of life style resulting from rapid economic growth are suspected to be important causes of the change in the prevalence of these diseases. Mass health examination was important and effective as a preventive measure against tuberculosis, especially as a means of early detection and early treatment. However, it is not now effective against chronic diseases. The screening examination has resulted in identifying many patients suspected of being ill. Every examiner must be able to distinguish pathologic findings from physiologic changes of aging. Every patient must, therefore, understand his/her individuality and evaluate the result of his/her efforts to improve life style by receiving a health examination. Accordingly, the aim of health examination has changed from early detection to health support for the examinee. During the decades when life expectancy was less than 50 years of age, it was not necessary for people to plan for retirement. Moreover, there was little burden on younger generations to provide care for the aged people because there were few old people more than 70 years of age and the birth rate was high. Nowadays, elderly people face many years of life after retirement and there are too many aged people in relation to the number of younger persons. As for medical care services, many new medical needs have emerged in recent years, including "quality of life," "palliative medicine in terminal care," "establishment of a primary care system" and "comprehensive care connecting health and medical care with welfare" etc. Improved living standards resulting from economic growth, called the "economic miracle" internationally, have helped to bring about a rapid and wide range of change in daily lifestyle, such as eating habits, working conditions and environment. The Ministry of Health and Welfare has made every effort to revise the laws in relation to health and medical care systems, in order to adjust to recent     

Keeping our elderly out of institutions by putting them back in their homes.

Public assistance for elders' health care often refuses to pay for needed medical treatment in the community, forcing elders into institutions, even when inappropriate. Increasing life expectancy has increased demand for intensive health and personal care services; and, while there has been increased federal support for home and community care, serious gaps are evident in acute and long-term care. Both financial and humanitarian considerations call for greater emphasis on home and community care, including provision of nonmedical in-home services, adult day health care, respite services for caregivers, and improved quality assurance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Access to health care. Part 2: Working-age adults

OBJECTIVES: This report presents data on access to health care for U.S. working-age adults, 18-64 years old. Access indicators are examined by selected sociodemographic characteristics including sex, age, race and/or ethnicity, place of residence, employment status, income, health status, and health insurance status. METHODS: Data are from the 1993 Access to Care and 1993 Health Insurance Surveys of the National Health Interview Survey (NHIS), a continuing household survey of the civilian noninstitutionalized population of the United States. The sample contained 61,287 persons in 24,071 households. RESULTS: In 1993, approximately 3 out of 4 working-age adults had a regular source of medical care. Nine out of 10 adults with health insurance had a regular source of care compared with 6 out of 10 adults without health insurance. For adults with a regular source of care, 86 percent received care in a private doctor's office, 9 percent in a clinic, and 2 percent in a hospital emergency room. The two main reasons given for not having a regular source of care were "do not need a doctor" (49 percent), and "no insurance can't afford it" (22 percent). Persons in the highest income group were more likely to report no need for a doctor (59 percent) than persons in the lowest income group (35 percent). About 40 percent of uninsured persons and 16 percent of insured persons reported an unmet medical need. CONCLUSIONS: Health insurance plays a key role in the access to medical care services. Persons who are uninsured or have low incomes are at the greatest risk of having unmet medical needs.     

Lipolytic response during spontaneous hypoglycaemia in insulin-dependent diabetic subjects

OBJECTIVE: To gather qualitative data regarding HIV/AIDS patients' perspectives about HIV-1 protease inhibitors (PIs), and about their experiences taking and adhering to regimens containing PIs. DESIGN: Six focus groups of persons under care for HIV were conducted between September and November 1996 regarding participants' knowledge, awareness, experiences when taking, and adherence to antiretroviral regimens containing PIs. An identical discussion guide was used to facilitate all six groups. Focus group proceedings were audiotaped, transcribed, coded for themes, and analyzed qualitatively. SETTING: HIV/AIDS practices of three teaching hospitals and two community health centers. PATIENTS/PARTICIPANTS: Fifty-six patients with HIV disease: 28 men and 28 women. MEASUREMENTS AND MAIN RESULTS: Knowledge and positive impressions of PIs were prevalent among this diverse group of persons with HIV, and did not differ by race/ethnicity or gender. Most knew that these were new, potent medications for treating HIV/AIDS. Networks of persons with HIV and medical providers were the most important information sources. Those taking PIs were aware that adherence to the regimen is important, and most were using special strategies to maximize their own adherence, but expressed considerable frustration about the central role these medication regimens had assumed in their life. A subset who did not believe they would adhere to these regimens had declined treatment with them. Motivating factors for taking and adhering to these complex regimens were improving CD4 counts and viral loads and the patient-provider relationship. CONCLUSIONS: Among those with HIV/AIDS, awareness of PIs and their effectiveness is substantial, owing to the impact of informal networks and medical providers. This early positive "reputation" of PIs may enhance motivation for adherence. Those who are taking PIs invest substantial effort adhering to these complex regimens, but resent the need to make medications the focus of their lives.     

Physical status as a moderator of depressive symptoms among older adults with dual sensory loss.

Objective: This study evaluated the ability of three measures of physical status—physical activity, physical condition, and body mass index (BMI)—to moderate the relationship between dual sensory loss (DSL) and depressive symptoms in older adults. Method: Nationally representative longitudinal data were used to develop multilevel models predicting depressive symptoms among two groups of older adults, 1380 who developed DSL during the study and 1308 without sensory loss. Results: All three measures were associated with depressive symptoms for persons who had or would develop a DSL: participation in physical activity and being in better physical condition were associated with lower levels of depressive symptoms, while lower BMI levels were associated with higher levels of depressive symptoms. All moderator variables had a larger effect for persons with DSL as compared to persons without sensory loss. Implications: The implication of these findings is that participation in a regular program of physical activity may provide multiple benefits to older persons with DSL. Families and health care providers can offer support for being physically active by ensuring the person has the best possible correction for the sensory losses, providing encouragement, and/or providing physical assistance with exercise. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An analysis of telephone health counseling for Japanese employees and their families abroad, "Japan health Care Line (overseas)"

In the past 6 years, the "Japan Health Care Line" has accumulated over 2,000 cases of telephone counseling calls, mainly on health problems, by Japanese living abroad on business, and their families, in 55 countries. The characteristics of these Japanese from medical aspects (physical and psychological), life style, and education were determined; and factors that influence their life abroad as well as some of their problems were analyzed. The role that telephone counseling can play in alleviating their anxiety, in helping them adapt, and in maintaining their health was also examined. The clients were Japanese employees and their families whose health insurance associations had joined this service. Data were recorded on a card for 14 items-the caller, the person needing the advice, age, sex, area of residence, length of stay, hour of call, number of calls etc. The data and main complaints were categorized in three ways: 1) by medical fields for business reports; 2) by coding the complaints; and 3) by the ICD-10 classification. Of the callers, 80% were in their 20's and 30's, meanwhile, as to the persons who need the advice, 30% of them were under 10, and 30% were in their 30's. There were many cases in obstetrics-gynecology, pediatrics, and general medical information. In the contents of the counseling, conditions or symptoms of the client were foremost, and together with advice on treatment, comprised half the calls. A study was made on the correlation between the clients' length of stay/location and the main complaints. Clients living abroad less than 1 year tended to call more, especially for vaccination, translation, mental problems, and medical systems, but did not call much in fields of obstetrics-gynecology, dentistry-oral surgery, examination data and treatments. Location did not make much difference in the fields of consultations, except for obstetrics-gynecology and dermatology. Middle and Near East countries had special characteristics to their consultations. There were differences in fields of counseling in calls from developing countries and developed countries. In the former countries, calls on orthopedics, urology, tropical diseases, and infectious diseases were numerous, while in the latter, pediatrics and mental problems were.     

Identification and management of pregnancy-related low back pain

A nonconcurrent prospective study was done on the relationship between a number of variables and the progression to AIDS among persons diagnosed with the human immunodeficiency virus (HIV). The variables included sociodemographic ones, behavioral ones, and, most importantly, those persons' difficulties in obtaining public health services for HIV/AIDS. The course of the infection was monitored from the first to the last visit to the health services by means of an individual, diagnostic-based classification, using categories established in 1993 by the Centers for Disease Control and Prevention of the United States of America. Participating in the study were 758 patients seen between 1989 and 1992 in the public AIDS referral services of the city of Belo Horizonte (Minas Gerais). All the persons had been diagnosed with HIV and classified in a pre-AIDS stage. Both the patients who developed AIDS during the study as well as those who did not were assessed according to the selected study characteristics. During the study period, 39.5% of the patients developed AIDS. For the group as a whole, the median time without AIDS was 32.4 months. Multivariate analysis showed that the patients who had less risk of developing AIDS were those who had had fewer than 8.8 medical consultations per year (relative risk = 0.36; 95% confidence interval, 0.26 to 0.50) and an interval of at least 6 months between consultations (RR = 0.37; 95% CI, 0.25 to 0.55). The risk was greater in patients age 30 and older (RR = 1.37; 95% CI, 1.03 to 1.84), in those who were not treated with zidovudine (AZT) (RR = 1.91; 95% CI, 1.37 to 2.64), and those who were initially classified in stage "B" of the disease (RR = 4.83; 95% CI, 3.59 to 6.48). The results of this investigation show the dynamics of the supply and demand of services by these patients, and the information will be useful in planning and organizing care for persons with HIV. Recommendations include giving priority to early intervention with a focus on ongoing outpatient care, and more study of the process that persons with HIV follow in seeking and obtaining health care.     

Disability among Canada's aboriginal peoples in 1991

In 1991, disability rates among adults were high for Aboriginal people, compared with the total Canadian population: 31% versus 13%. For all ages and levels of education, Aboriginal disability rates were much higher than those of Canadians overall. While most younger Aboriginal persons with a disability were only slightly disabled and did not need help with their daily activities, at age 55 and over, more than half of Aboriginal persons with a disability were either moderately or severely disabled and required such help. Nonetheless, most of the Aboriginal population with disabilities who needed help received it, so only a small proportion of them had unmet needs for assistance. The need for assistance, however, increased with the severity of disability. Recent improvements in survivorship mean that more Aboriginal people will live to older ages, at which disability rates are higher. This has implications for their need for health and social services, and the associated costs. Statistics Canada's 1991 Aboriginal Peoples Survey (APS) was used to examine the prevalence and severity of disability and the degree of dependence in the Aboriginal population. Where possible, these results are compared with data for the total Canadian household population from the 1991 Health and Activity Limitation Survey (HALS).     

The misdiagnosis of epilepsy: findings of a population study

The aim of the study was to evaluate reasons for anti-HIV testing among persons admitted to Outpatient Counseling Unit. Serum examination for antibodies against HIV were performed in 389 persons during 8 years of the Unit activity. The most frequently it was analysed in intravenous drug users. However there are still many persons who are urged for this analysis before invasive medical procedures. Knowledge on HIV/AIDS in Poland seems to remain on the very low level in public as well as in medical staff.     

Psychosocial evaluation on the correct recollection of periodic medical checkups of workers. 1. The ratio of correctly recalled results of medical checkups

To investigate the usefulness of a periodic medical checkup at the workplace from the standpoint of remembering the results, a survey was performed by a self-rating questionnaire on 424 industrial workers in a certain manufacturing company. The questionnaire included several items, such as their recalled abnormal medical findings and follow-up toward them, Breslow's 7 health practices, Goldberg's 12 selected items from the Japanese version of the General Health Questionnaire, and other original health related items. The study was conducted a month after the workers received their results. A total of 391 (290 males and 101 females) or 92.2% responded to the questionnaire. Several factors, such as age, gender, the type of occupation, and perceived health status were significantly correlated to the recalled results of medical checkups, but, only age and the way of observing the results were in accordance with the actual results. Only forty-nine percent of the responders correctly remembered their results. Age and perceived health status were significantly correlated to the exact recollection of the results. In particular, those who had poor perceived health status tended to have a wrong understanding of their medical results. Furthermore, there were those with the highest averaged GHQ scores who responded as having some abnormal findings even though no abnormalities were discovered in the medical checkups. On the other hand, there were those with the lowest averaged GHQ scores who answered that they had no abnormal findings even though some abnormalities were revealed in the medical checkups. The frequency of correct follow-up of the results was lower than the exact recalling of the results. In addition, those who made a mistake in the follow-up were inclined to have an optimistic view. Therefore, comprehensive health care for precise recalling of the results of medical checkups should be required to improve abnormal findings or maintain a good health status.     

Multidimensionality of oral health in dentate adults

OBJECTIVES: An understanding of the validity and usefulness of self-reported measures (as distinct from clinically determined measures) of oral health is emerging. These self-reported measures include self-rated oral health (SROH). Three objectives were to: (1) describe self-rated oral health in dentate adults, (2) quantify associations between self-rated oral health and other measures of oral health (oral disease and tissue damage, pain and discomfort, functional limitation, and disadvantage), and (3) assess the construct validity of a model of oral health proposed herein. METHODS: The Florida Dental Care Study is a longitudinal study of oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. RESULTS: The prevalence of self-rated oral health decrements was substantial; approximately one fourth of subjects reported their oral health as only fair or poor. Bivariate and multivariate results provided consistent evidence of the construct validity of the proposed model of oral health. Additionally, the salience of one measure of dental appearance suggests that persons may use esthetic cues when rating their oral health. CONCLUSIONS: The proposed multidimensional model of oral health has construct validity. Self-rated oral health is affected by oral disease and tissue damage, oral pain and discomfort, oral functional limitation, and oral disadvantage. These self-reported measures and the proposed model should provide useful information for dental care effectiveness research. General health status has been disaggregated into the "physical" and the "mental;" an additional separation into the "oral" aspects of health seems warranted.     

The political agenda of health care for African Americans

Health care reform presents both challenges and opportunities for African Americans. On the one hand, reform could result in the closure of black medical institutions and fewer black physicians. On the other hand, reform gives African Americans an opportunity to bargain for available resources to gain equality in health care services. To this end, the Volunteer State Medical Association has been involved in state health care reform. Its goals are to resolve the current financial crisis at black medical institutions; to assist in the survival and development of local black managed care organizations; to assure that all licensed black physicians have continued access to patients; and to develop black-owned health-related businesses. The association has formed the Tennessee Coalition for Quality Health Care, a group of African American politicians, physicians, educators, and health care administrators who can negotiate with state and federal officials in the issue of health care reform.     

Physical functional level and chronic back pain. Methods for an objective assessment as a part of diagnosis and treatment

Low back pain is a benign situation which affects 50 to 80% of all people in the course of their lives. Usually it heals within some weeks. The few who do not get better within some months are in serious danger of ending up in a human, social and medical impasse. In this respect, ordinary clinical examination methods are of limited value. Functional examination is a very important tool both clinically and from the aspect of health insurance. Work physiological function measurements give possibilities of comparing the information on patients with normative data. They also establish a basis for quality control after treatment. The purpose of this article is to describe measurement methods to assess the level of physical function of persons with chronic back pain. The criteria for choosing the methods of examination are also discussed.     

Geriatric assessment in oncology

With the anticipated growth in the numbers of elderly persons, a higher prevalence of cancers among older persons is expected; as a result, oncologists will treat larger numbers of older persons in their practices. Clinicians caring for older persons with cancer must recognize the heterogeneity of the elderly population and focus their assessments and care plans accordingly. The author reviewed literature and drew conclusions regarding geriatric assessment in several key areas: the medical, cognitive, affective, functional economic, and environmental status of patients; social support for patients; and advance directives. They concluded that for younger and healthier seniors, simple probes for the presence of common geriatric problems may suffice, but traditional means of medical assessment should be supplemented by brief screening for common geriatric conditions and nonmedical issues that are of particular relevance to the health of older persons. Assessment instruments can be used to guide these brief evaluations, but results must be interpreted in the context of the limitations of the instruments used. Patients who are frail or at high risk for functional decline or nursing home placement should receive more extensive evaluation by individual practitioners or by a multidisciplinary team of health care professionals who can provide comprehensive geriatric assessment. By broadening their assessment skills to include domains that are beyond traditional internal medicine and oncology training, oncologists can better serve their older cancer patients.     

Interactions between criminal justice and other areas of law from the viewpoint of the civil rights judge

More than in the past, patients are consulting lawyers to check medical treatment for malpractice. One of 10,000 city-inhabitants institutes proceedings for compensations. In the past, a charge was brought at the same time to achieve examination of patients records and to obtain an expert opinion at government expenses. Due to recent jurisdiction, the patient got the right to examine treatment records without the necessity to specify his reasons. Settlement institutions of the society of physicians of Germany facilitate an examination of a treatment procedure for mistakes without costs. Therefore, there is no more incentive for a charge to achieve compensations. The continuation of civil proceedings may not depend on the result of the investigation proceedings due to the different kind of evidence. The special duties of civil courts working with medical liability and expert opinions seem to show that civil proceedings are suited the best to clarify a dispute between physicians and patients. This also avoids to pillories the physician.     

The international transfer of medical technology--an analysis and a proposal for effective monitoring

The international transfer of medical technology to the developing countries occurs at four levels--medical education, research, and missions; multinational corporate transactions; technical assistance projects sponsored by the World Health Organization; and bilateral foreign aid programs. In this article, a proposal is made for effective monitoring of international medical technology transfer through political and legal means, including a specific code of conduct for corporations engaged in medical technology transfer. The development of "intermediate health technologies" along the lines suggested by E. F. Schumacher, and the advantages of such an innovation in terms of population issues and economic development are also discussed.