Спонсорирано от:      Dreyfus Health Foundation

DHF, 205 East 64 Street, Suite 404

New York, NY 10021

E-mail: Postmaster@thf.org

http://www.thf.org

                                        Fax #  212-371-2776

Съдържание

 

УВОД/INTRODUCTION

-     Мероприятия по програмата “Решаване на проблеми за по-добро здраве”

-     Problem Solving for Better Health Program Events

ИНФОРМАЦИЯ ОТ MEDLINE/MEDLINE INFORMATION

ПРОЕКТИ В ХОД

-     “Очите на децата - светлината на света”

-     Програма за активна арт-терапия с пациенти на Диспансер за психично болни - гр. Русе

-     Образователна програма за стационарните пациенти на Диспансер за психично болни - гр. Русе

-     Програма за запознаване на сътрудниците от “Телефон на доверието” със съвременни психотерапевтични и консултативни методи

-     Здравно-възпитателна програма за безнадзорните деца посещаващи приюта на БЧК - Русе

-     Програма за обучение на общи хирурзи в техниките на ендоскопската хирургия

-     Програма за обучение на болни с хронична бъбречна недостатъчност за необходимия им диетичен режим и начин на живот

-     Необходимост от пълноценно обучение на болните от бронхиална астма с цел подобряване качеството на живот и контрол на симп-томите на симптомите на болестта

-     Програма за оценка на нуждите от психиатрична помощ за децата, обхванати от ОбКБИПМН - Русе

-     Необходимостта от профилактика, ранна диагностика и лечение на остеопорозата при рискови групи пациентки в работоспособна възраст

-     Одобряване на ранната диагностика на карцином на простатата

-     Практическо обучение на общопрактикуващи лекари в Русенския регион

-     “777 без дрога”

-     Програма за контролиране на кръвно-захарното ниво у деца, болни от захарен диабет

-     Програма за ранна рехабилитация на деца, прекарали перинатална асфиксия

-     Програма за ранна диагностика и своевременно лечение на ретинопатията у недоносени деца от гр. Русе

-     Просветно-профилактична програма за намаляване риска от мозъчно-съдова болест

-     Програма за обучение на родители за обгрижване на деца с остри заболявания

-     Алтернативна професионална подкрепа за злоупотребяващи с дрога ученици и семействата им

-     Здравно-образователна програма за населението по правните аспекти на здравно-осигурителната система

-     Социално-рехабилитационна и терапевтична програма за деца с муковисцедоза

-     Организиране на група за самопомощ на болни от остеопороза

-     “За повече години живот и повече живот през годините”: интервюиране на хронично соматично болни за възможностите им

ROUSE-GIURGIU INITIATIVE OF THE PROBLEM SOLVING FOR BETTER HEALTH PROGRAM, NOVEMBER 1999 PROJECT STATUS AS OF APRIL 2000 (SUMMARIES)

 

 

Мероприятия по програмата “Решаване на проблеми за по-добро здраве

 

Семинар за проследяване на работата по проекти

    

     В семинара, проведен на 8 април в Русе, участваха координатори на проекти, разработени през ноември 1999 година. Участниците работиха в три групи, заедно с фасилитаторите от Плевен - доц. Мария Александрова, д-р Камен Каменов и г-жа Янка  Цветанова, и д-р Пламен Панайотов, д-р Светослав Дачев, д-р Павел Бойчев и д-р Бисерка Машкова - от Русе. Обсъдена бе работата по 29 проекта. Информация за нея до април 2000 г. е публикувана в настоящия брой на бюлетина.

     От обсъждането по време на работата в малките групи и пленарното заседание пролича добрата работа по голяма част от про-ектите и сътрудничеството между отделните проекти.  Ползотворна е и работата на местните медии - радио, телевизия и преса по популяризирането както на информация по проектите, така и на здравни знания. Координаторите на проекти получават подкрепа и от местни правителствени и неправителствени организации.

 

Семинари “Решаване на проблеми за по-добро здраве” - Плевен

    

     На 25 април в хотел “Балкан” в Плевен се проведе семинар за проследяване на работата по проекти, разработени от медицински сестри, участвали в предишни семинари.  Представена бе работата по 19 проекта.

     От 26 до 28 април се проведе нов семинар, организиран от Здравна фондация “Драйфус” /САЩ/, Фондация “Международно сътруд-ничество в медицината” /Англия” , Клуб “Отворено общество” - Плевен и Факултет по здравни  на Висш медицински институт - Плевен. Студентите от Факултета по здравни грижи с особен интерес посрещнаха изнесената  от Мадам Шийла Куин, бивш директор на Кралския колеж за медицински сестри в Лондон и президент на фондация “Меж-дународно сътрудничество в медицината” и от г-жа Шийла Мърфи, член на управителния съвет на същата фондация, лекция на тема “Сестринството през новото хилядолетие”.

     Поздравителни адреси до участниците и организаторите на семинара бяха получени от д-р Стойко Кулаксъзов от Министерството на здравеопазването и от д-р Дора Мирчева - от Офиса на СЗО в България.

По време на семинара участниците бяха подпомогнати в разработването на проекти по методологията на програмата “Решаване на проблеми за по-добро здраве” от екип от фасилитатори - Мадам Шийла Куин, г-жа Шийла Мърфи, доц. Гена Грънчарова - Декан на факултета по здравни грижи, доц. Мария Александрова, д-р Камен Каменов, г-жа Янка Цветанова и г-жа Милка Василева.

     Подготвени бяха 29 проекта:

 

     -   Ефективно използване на медицинските консумативи в сестринските грижи в Университетска болница - Стара Загора - Дарина Тотева

     -   Здравно - възпитателна програма за профилактика на затлъс-тяванията чрез рационално хранене и активен двигателен живот сред учениците на СОУ “Христо Ботев” град Никопол -Вероника  Владимирова

     -   Разкриване на кът за забавно-възпитателна работа, с цел създаване на нормален психоклимат, подобряване на условията и качеството на работа в Детско отделение при Общинска болница “Св.Ив.Рилски” гр. Козлодуй - Даниела Николова

     -   Осигуряване на пълноценно хранене на 20 - 30 деца от 0 - 3 години при лоши социално-битови условия и ниски доходи в град Свищов -Венцислава Георгиева

     -   Обучение на шофьорите от ЦСМП - гр.Плевен за оказване на първа медицинска помощ при ПТП - Виолета Василева

     -   Своевременно обхващане на пациентите с травматично-ортопедични увреди за физикална терапия и рехабилитация в КФТР - ВМИ град Плевен - Богдана Друмева

     -   Образователна програма, касаеща ефективното и рационално използване на материалите -Анжела Щрос - Колева

     -   Повишаване броя на обучените по сестринския метод медицински сестри - наставници, работещи в детска клиника при Висш медицински институт - град Плевен - Анка Христова

     -   Споразумение между общопрактикуващите лекари, завеждащи отделения, сестрите и лабораторния екип във връзка с рационалното използване на реактивите за биохимични изследвания -Антоанета Лукановска

     -   Здравно - просветна програма за профилактика на мозъчните инсулти при рискова група на възраст 50 - 70 години от град Стара Загора - Иванка Минчева

     -   Обучение за безопасна работа в клинична лаборатория по време на учебна практика на студентите от Медицински колеж  гр.Плевен специалност Медицински лаборанти - Иванка Стойкова

     -   Психологична подкрепа на болните с новооткрити онко-логични заболявания -Иванка Иванова

     -   Здравно - възпитателна програма за профилактика на артериална хипертония сред работниците на ж.п. гара - Плевен - Първи район -Лидия Василева

     -   Профилактика на гръбначните изкривявания при учениците от 1 - 4 клас в училище “Крум Попов” в гр. Левски - Кичка Симеонова

     -   Здравно-просветна програма за предпазване от ехинококоза сред персонала, децата и родителите от ДГ “Чучулига” - гр. Плевен - Надка Христова

     -   Програма за промоция на здравето сред работещите в ЕООД “Тролейбусен транспорт”гр.Плевен - Марияна Михайлова

     -   Внедряване на вакутейнери за вземане на кръв за изследване на кръводарителите в регионалния център по трансфузионна хематология - град Плевен - Наталия Георгиева

     -   Програма за обучението диспансеризирани в гастроентеро-логичната клиника болни с хепатит “B” и “C” за прилагане на лечение с интерферон в домашни условия -Мая Пелкова

     -   Здравно-просветна програма за повишаване инфор-мираността за хламидиалната инфекция- Пламена Полихронова

     -   Здравно-просветна програма за хипертоници от една лекарска практика  в гр. Каспичан - Милена Недева

     -   Намаляване на случаите с вътреболнични инфекции в отделението за следоперативна реанимация към Институтска болница -град Плевен - Поля Веселинова

     -   Здравно-просветна програма за хипертоници /50-70 г/ в с. Рибен - Силвия Пешева

     -   Здравно - възпитателна програма, проведена сред учениците от Х - В клас  на СОУ - град Велико Търново -Стелка Коева

     -   Обособяване на самостоятелен детски интензивен сектор в Център за спешна медицинска помощ във Враца - Цветелина Игнатова

     -   Здравно-просветна програма за профилактика на фебрилните гърчове при деца до 1 год. във Враца - Цветелина Симеонова

     -   Образователна програма за подобряване качеството на сестринските грижи -Цветослава Цветкова

     -   Намаляване честотата на зъбен кариес сред 156 деца на възраст 6 - 10 години от СОУ “Христо Смирненски” - град Искър чрез медикаментозна флуорна профилактика и обучение в поддържане на добра орална хигиена - Яна Глоговска

     -   Здравно-просветна програма за диабетици в една лекарска практика - Ирена Манолова

     -   Подобряване на качествотo на сестринските грижи за болни със суициден риск - Мария Велчева

 

     В следващия брой очаквайте материали за семинарите през май /Варна/ и юни /Плевен/.

 

 

 

Problem Solving for Better Health Program Events

 

PSBH Follow-up Workshop

 

Coordinators of projects from the Rouse&Giurgiu Initiative PSBH Workshop participated. They worked in three groups, together with facilitators from Pleven ( Assoc. Prof. Maria Alexandrova, Dr. Kamen Kamenov and Mrs. Yanka Tzvetanova) and the local coordinators Dr. Plamen Panayotov, Dr. Svetoslav Dachev, Dr. Pavel Boichev and Dr. Biserka Mashkova. The progress of 29 projects was discussed, and reports on most of them can be seen in this issue.

     Discussions in the groups and the plenary sessions showed good progress of most of the projects, as well as cooperation between projects. The local media brought publicity to the project activities. Projects were also supported  by local government and NGOs.

    

PSBH Workshop and Follow-up Workshop for Nurses

    

On April 25th, a follow-up workshop was held in Pleven at the Balkan Hotel. Nurses, who participated in former PSBH workshops presented the progress of their projects. coordinators of 19 projects discussed have completed them, and are now trying to replicate them.

A new PSBH workshop started on April 26th. The workshop was organized by the Dreyfus Health Foundation - USA, Action in International Medicine (AIM) - UK, the Open Society Club in Pleven and the Faculty of Nursing of the University School of Medicine in Pleven. The students of the faculty of Nursing were all excited by the “Nursing in the New Millennium” talk Dame Sheila Quinn (Chairman of AIM) and Ms. Shelagh Murphy (Board Member of AIM) gave on two successive days.

Greeting addresses were sent to the participants and organizers of the workshops by Dr. Stoiko Koulaksazov of the Ministry of Health and by Dr. Mircheva of the Sofia WHO Office.

Participants were assisted in the preparation of their projects by Dame Sheila Quinn and Ms. Shelagh Murphy, and the local facilitators Assoc. Prof. Gena Grancharova, Dean of the Faculty of Nursing, Assoc. Prof. Maria Alexandrova, Dr. Kamen Kamenov, Mrs. Yanka Tzvetanova and Mrs. Milka Vassileva, President of the Bulgarian Association of Nurses. Participants prepared 29 plans of action:

Organizing effective use of medical material by nurses at the University Hospital in  Stara Zagora - Mrs. Darina Toteva -

Health education to prevent obesity among school children  in a School in Nikopol -Mrs. Veronica Vladimirova

Organizing a playground on the premises of the pediatric ward in Kozlodui to improve quality of patient care -Mrs. Daniela  Nickolova

Providing proper nutrition for children aged 1—3 of low-income families in Svishtov - Mrs. Ventzeslava Georgieva

Training drivers at the Emergency Center in Pleven to give first aid in road accidents - Mrs. Violeta Vassileva

Organizing timely referral for rehabilitation of patients with orthopedic traumas by opening a day-patient center - Mrs. Bogdana Droumeva

An educational program on rational usage of hospital materials in the Regional Hospital in Rouse - Mrs. Angela Straus - Koleva

Training nurses to use the nurses’ method in their work on the pediatric ward in Pleven - Mrs. Anka Christova

A program to avoid unnecessary prescription of biochemical tests in general practice and in the hospital in Knezha - Mrs. Antoaneta Loukanovska

Health education among risk patients aged 50-70 in Stara Zagora to prevent stroke - Mrs. Ivanka Mincheva

Training students at the Nursing College in Pleven to follow safety procedures while working in the clinical laboratory - Mrs. Ivanka Stoikova

Providing psychological support for newly diagnosed cancer patients - Mrs. Ivanka Ivanova

Health education to prevent hypertension among workers at the railway station in Pleven - Lidia Vassileva

Prevention of spinal deformities among children aged 7-10 in a school in Levski - Mrs. Kichka Simeonova

Health education on echinococcosis among staff, children and parents of a kindergarten in Pleven - Mrs. Nadka Christova

health promotion among the drivers of trolley-buses in Pleven - Mrs. Mariana Michailova

Introduction of vacuum containers in examining donated blood at the regional blood transfusion center in Pleven- Mrs. Natalia Georgieva

Training hepatitis B&C patients who receive Interferon treatment outside hospital - Mrs. Maya Pelkova

Health education on chlamydial infection among patients of a gynecology consulting room in Rouse - Mrs. Plamena Polichronova

Health education for hypertensive patients in a general practice in Kaspichan - Mrs. Milena Nedeva

A program to reduce the incidence of nosocomial infections in the post operative intensive care unit at the University Hospital in Pleven - Mrs. Polya Vesselinova

A health education program for hypertensive adults /50-70/ in the village of Riben - Mrs. Silvia Pesheva

A health education program on STDs among students aged 17 in a high school in Veliko Turnovo - Mrs. Stelka Koeva

Organizing a pediatric admission room at the Emergency Center in Vratza - Mrs. Tzvetelina Ignatova

Health education to prevent febrile seizures among children aged 0-1 years in Vratza - Mrs. Tzvetelina Simeonova

A program to improve the quality of nursing care  - Mrs. Tzvetoslava Tzvetkova

Decreasing caries incidence among children aged 6-10 by health education and fluoride protection - Mrs. Yana Glogovska

Health-education for diabetic patients in one general practice in Kaspichan - Irena Manolova

Improving the quality of nursing care for patients with suicidal tendencies - Maria Velcheva

 

     The activities in May (Varna Anti-Drug Abuse PSBH Workshop) and  the Pleven Initiative Follow-up Workshop will be presented in the next issue.

 

информация от medline

 

церебрална парализа

 

TI:    [The role of neuropaediatrician in the comprehensive management of children with cerebral palsy]

AU:   Kitahara-T

SO:   No-To-Hattatsu. 1998 May; 30(3): 238-43

AB:   The child with cerebral palsy becomes the adult with cerebral palsy. In Japan early detections and treatments of CP have enthusiastically brought into practice over the last twenty years. But cerebral palsy could not be cured. Children/adults with CP should be provided com-prehensive treatments and cares so that they can perform their daily activities and fulfil their social roles expected during their lifetime. There are two concepts needed to provide comprehensive management of CP. The first is a medical model that assesses CP in the following manner: etiology-pathology-manifestation. The other is a disability model based on three seperate categories suggested by WHO: impairment-disability-handicap. Keeping these in mind, total effective approaches to children/adults with CP were discussed. Neuropaediatricians are asked to play important roles which contain epidemiologic activities, early detections, and medical treatments. They should refer clients and their families to related professionals if necessary and have also knowledges of assisstive equipments to enrich their lives.

 

 

TI:    The contribution of developmental surveillance to early detection of cerebral palsy.

AU:   Lindstrom-K; Bremberg-S

SO:   Acta-Paediatr. 1997 Jul; 86(7): 736-9

AB:   A retrospective study of the contribution of examinations at Child Health Centres (CHC) for early detection of cerebral palsy (CP) was performed in 23,924 children, born in 1986-90, in the south-western part of Stockholm County. The outcome assessed was age of referral to a habilitation unit. A total of 66 children with CP (2.76/1000) were identified through the register at the responsible habilitation unit. The age of referral was, median 8 months, mean 12.4 months and range 0.5-54 months. A peak of referrals at 8-9 months was produced by CHC checks at 6 months of age. No other examination at the CHC resulted in a significant number of referrals. Nineteen records from CHC concerning moderate and severe cases were reviewed. Out of all examinations with aberrant findings only 11/20 resulted in referrals or further examinations. No child with moderate or severe CP was referred due to developmental screening test findings only.

 

 

TI:    [Involuntary movements and birth injuries to brain]

AU:   Kodama-K

SO:   No-To-Hattatsu. 1997 May; 29(3): 220-6

AB:   Asphyxia may play an important role in the patho-genesis of cerebral palsy (CP) in a subpopulation of patients, although this has recently been questioned by some investigators. Here I describe the results of our analyses into the involuntary movements of children with CP, which resulted from perinatal hypoxic brain damages. Based on cranial CT or MRI findings, the patients were divided into five groups: A, those showing high density on CT in the basal nuclei (bilateral thalami in particular); B, those showing destruction of bilateral putamina; C, those with diffuse low-density areas in the cerebral white matter on CT during the neonatal period that evolved later into polycystic leukomalacia; D, those with similar low-density areas which subsequently resolved; and E, those without any pathological findings. Using video records, I demonstrated the motor development of six cases with CP. Patients of Group A showed pure athetosis with hypotonia. A patient of Group B had severe athetoid CP with spasticity, being unable to right his trunk and neck. A case of Group C developed severe spastic quadriplegia with athetosis. His mental ability was retained to some extent. In Group D, there was moderate spasticity and mild athetosis. A patient with transient anxia had disturbance in the coordinated finger movements. Cases with choreic movements had no particular CT or MRI findings. Even in the severest of these cases, distinction from normal infants was difficult in the very early infancy. After four to five months, locomotive prognoses were well predicted by the patients’ ability to control their trunk. To know more about the pathogenesis and CP and to elucidate the significance of involuntary movements, further data should be accumulated by clinical obser-vations on motor development, and by imaging studies.

 

 

TI:    [New approaches in the treatment of speech disorders in children with an organic brain lesion]TT: Novye podkhody v lechenii rechevykh narusheni_i u dete_i s organicheskim porazheniem golovnogo mozga.

SO:   Lik Sprava. 1999 Apr-May. (3). P 121-4.

MH: Cerebral Anoxia:*CO/DI. Cerebral Palsy:*CO/DI. Speech Disorders:DI/ET/*TH. Adolescence. Brain Mapping. Child. Child, Preschool. Combined Modality Therapy. Echoencephalography. Electrocardiography. Engraving and Engravings. Check Tags: Female.. Human.. Male.

AB:   Speech disorders encountered in children presenting with neurological pathology make their medical and social rehabilitation a real challenge. Overall sixty children were examined. Of these, 38 had infantile cerebral paralysis, 22 that being presented with sequelae of the hypoxic affection of the brain in ante- and perinatal period, who exhibited speech disorders (alalia, dysarthria, retarded speech development). Described in the paper are features of bloodflow disorders in intracranial and vertebral arteries as evidenced by ultrasonic Doppler technique and changes in brain bioelectrical activity according to findings from electroencephalomapping. In 53 patients, a positive effect was obtained as a result of therapy conducted in accordance with the stimulation type techniques (electroscalp therapy against the background of intramuscular administration of nicotinic acid plus laser therapy, transcutaneous electrostimulation, employment of such drug preparations as cogitum, nero-force, sirdalud).

 

 

AU:   Amari A, Slifer KJ, Gerson AC, Schenck E, Kane A

AD:   Behavioral Psychology Department, Kennedy Krieger Institute, Baltimore, Maryland 21205, USA.

TI:    Treating selective mutism in a paediatric rehabilitation patient by altering environmental reinforcement contingencies.

SO:   Pediatr Rehabil. 1999 Apr-Jun. 3(2). P 59-64.

MH: Behavior Therapy:*. Mutism:*RH. Child. Verbal Behavior. Check Tags: Case Report.. Female.. Human.

AB:   Selective mutism is a disorder which can cause severe social and academic impairment, and for which a wide variety of treatment approaches have been used, with varying degrees of success. Selective mutism can be conceptualized as the lack of generalization of a class of operant responses (e.g. audible and comprehensible verbalizations) across environmental contexts. The rehabilitation hospital setting, in which the patient is seen daily by multiple people in multiple settings, is particularly well-suited for implementing a systematic behavioural intervention to establish verbal behaviour and simul-taneously reinforce its generalization. Data are presented on a 7-year-old female admitted to a rehabilitation hospital following orthopaedic surgery, who met the DSM-IV diagnostic criterion for selective mutism. Additional medical diagnoses included cerebral palsy, microcephaly, and mild mental retardation. A behavioural programme was developed and implemented to reinforce dif-ferentially first any communication, then verbal communication across staff and settings. Results were evaluated using a modified multiple baseline across settings design, and demonstrate that verbal, written, and tangible reinforcement effectively increased verbal behaviour where it previously rarely occurred. Results are discussed in terms of the relationship between selective mutism, social phobia and related disorders. The theoretical roles of behavioural phenomena (discri-minative stimuli, stimulus generalization) in the deve-lopment and treatment of these disorders are discussed.

 

 

Превенция на съдови заболявания

 

TI:    Lessons from hypertension trials.

AU:   Hennekens-CH

SO:   Am-J-Med. 1998 Jun 22; 104(6A): 50S-53S

AB: Hypertension is a well-established risk factor for stroke, myocardial infarction (MI), and premature cardiovascular death. Even mild elevations of blood pressure (i.e., diastolic blood pressure >90 and <110 mm Hg) yield increased risk. In fact, mild-to-moderate hypertension is more common than severe hypertension and accounts for a greater proportion of the deaths and serious nonfatal vascular events. The treatment goal is to make optimal use of antihypertensive drug therapy while encouraging patients to implement lifestyle changes such as weight loss, sodium restriction, decreased alcohol intake, and increased exercise. Pharmacologic therapy of mild-to-moderate hypertension can significantly reduce the incidence of stroke, MI, coronary artery disease, vascular mortality, and total mortality. Beta blockers and diuretics should continue to be used as first-line therapy until there is direct and reliable evidence from large-scale randomized trials with clinical endpoints for newer agents such as calcium antagonists and angiotensin-converting enzyme inhibitors.

 

 

TI:    Risk factors and antiplatelet therapy in TIA and stroke patients.

AU:   Puranen-J; Laakso-M; Riekkinen-P Sr; Sivenius-J

SO:   J-Neurol-Sci. 1998 Feb 5; 154(2): 200-4

AB: Antiplatelet treatment is well established in the secondary prevention of ischemic cerebrovascular events. The reasons for the occurrence of stroke, even though the patient receives drug treatment, have remained unclear. We performed a subgroup analysis of the European Stroke Prevention Study (ESPS 1) to investigate the efficacy of treatment in patients with different cardiovascular risk factors. The ESPS 1 recruited 1306 patients with TIA, RIND or stroke in one single center of Kuopio in Finland. The patients were treated with aspirin 990 mg/day+dipyridamole 225 mg/day or placebo for 2 years or until an endpoint. The endpoints were stroke or death from any cause. The risk factors for endpoints were analyzed by Cox univariate regression analyses. The effect of a single risk factor on the efficacy of antiplatelet therapy was analyzed by Cox proportional hazards model in subgroups according to the significant risk factors found in the univariate analysis. The efficacy of treatment was statistically significant in all subgroups except diabetics and current smokers for the stroke endpoint. When the combined endpoint of stroke or death was used, the treatment failed also to show statistical significance in patients with coronary heart disease. This lack of efficacy might be due to the small sample size. The efficacy of treatment was significantly better in TIA patients than in stroke patients when analyzed with stroke as an end point. This study provides strong evidence that the effectiveness of antiplatelet treatment in ischemic stroke and TIA patients is independent of most car-diovascular risk factors. Furthermore, all patients with TIA and ischemic stroke should receive secondary prevention regardless of whether or not there are risk factors.

 

 

TI:    Survey of the causes of stroke among Mexican Americans in South Texas.

AU:   Worley-KL; Lalonde-DR; Kerr-DR; Benavente-O; Hart-RG

SO:   Tex-Med. 1998 May; 94(5): 62-7

AB: Management strategies for optimal stroke prevention depend on the cause of threatened stroke. We know relatively little about the etiology of stroke in Mexican Americans, who make up one quarter of the population in Texas. A retrospective case series of 159 consecutive patients hospitalized in San Antonio, Tex, for acute, first-ever stroke compared risk factors, features, and causes of stroke between Mexican Americans and whites. Mexican Americans who had strokes were significantly younger than whites and had diabetes mellitus more often. Intracerebral hemorrhage and lacunar infarcts occurred often in Mexican Americans. Ethnicity appeared to be an independent risk factor for lacunar infarction. Mortality and functional outcome at the time of hospital discharge were similar in Mexican Americans and whites. Intrinsic small-vessel disease causing lacunar infarcts and intracerebral hemorrhage accounts for about one half of strokes in Mexican Americans. Stroke among Mexican Americans in South Texas has a distinctive profile with implications for its prevention.

 

 

TI:    [Control of blood pressure: a key factor in prevention]

AU:   Suter-PM; Hasler-E; Vetter-W

SO:   Schweiz-Rundsch-Med-Prax. 1998 Jan 28; 87(5): 145-9, 152-6

AB:   An increase in blood pressure represents one of the most common conditions in daily medical practice. Many different factors are regarded as risk factors for a stroke. Hypertension, cardiac diseases, atrial fibrillation, smoking, diabetes mellitus, alcohol consumption and dyslipidemia are central stroke risk factors. The pathophysiological importance of these different risk factors is discussed. Hypertension represents the most prevalent risk factor for stroke in the general population. A decrease in blood pressure leads in general to a reduction of the risk. Besides an optimal pharmacological control of blood pressure miscellaneous non-pharmacological means should be implemented in any patient with high blood pressure. The most important non-pharmacological means of blood pressure control are discussed in the context of stroke risk.

 

 

TI:    Impact of multiple risk factor profiles on determining cardiovascular disease risk.

AU:   Yusuf-HR; Giles-WH; Croft-JB; Anda-RF; Casper-ML

SO:   Prev-Med. 1998 Jan-Feb; 27(1): 1-9

AB:   BACKGROUND: We examined the association between clustering of risk factors and the risk for coronary heart disease, stroke, and all-cause mortality. METHODS: Data from the First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study (N = 12,932) were used to estimate the relative risk for coronary heart disease (N = 2,255), stroke (N = 929), and death from any cause (N = 4,506) by the number of cardiovascular disease risk factors present. Risk factors included current smoking, overweight, hypertension, high blood cholesterol, and diabetes. RESULTS: The proportions of respondents with 0, 1, 2, 3, or > or = 4 risk factors were 25.0, 32.8, 27.8, 12.3, and 2.1%, respectively. Relative risks for coronary heart disease associated with having 1, 2, 3, and > or = 4 risk factors were 1.6 (95% confidence interval [CI] 1.4, 1.9), 2.2 (95% CI 1.9, 2.6), 3.1 (95% CI 2.6, 3.6), and 5.0 (95% CI 3.9, 6.3), respectively. Relative risks for stroke associated with the same risk levels were 1.4 (95% CI 1.1, 1.8), 1.9 (95% CI 1.5, 2.4), 2.3 (95% CI 1.7, 3.0), and 4.3 (95% CI 3.0, 6.3), respectively. Similar results were observed for all-cause mortality. CONCLUSIONS: Risk for cardiovascular disease and all-cause mortality increased substantially with each additional risk factor. This supports the continued need for primary prevention of cardiovascular disease risk factors.

 

 

TI:    JNC V revisited: standard of care or individualized treatment for hypertension?

AU:   Alderman-MH

SO:   Am-Heart-J. 1998 Feb; 135(2 Pt 2): S8-15

AB:   The fifth report of the National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) has weathered the test of time fairly well. The significant new dimensions of the 1992 document included (1) a new classification system reflecting the recognition that risk from hypertension does not arise at a specific blood pressure level but is continuous, (2) an expanded list of agents suitable for antihypertensive therapy, (3) recognition of the significance of systolic blood pressure as a risk factor, particularly isolated systolic blood pressure in the elderly, (4) identification of diuretics and beta-blockers as agents of first use, and (5) recognition that, in addition to level of blood pressure, absolute risk for cardiovascular disease events should influence the nature of therapy. Concern for matching therapeutic efforts with actual risk of disease and potential for benefit has grown. Some have recommended that drug therapy be reserved for those whose absolute risk of a CVD event is above an arbitrary threshold. The next JNC report is likely to be more precise in linking treatment recom-mendations to the actual level of risk, as well as level of blood pressure, particularly within the broad range of levels where, in JNC V, the decision to treat was left to individual judgment.

 

 

TI:    Low circulating folate and vitamin B6 concentrations: risk factors for stroke, peripheral vascular disease, and coronary artery disease. European COMAC Group [see comments]

AU:   Robinson-K; Arheart-K; Refsum-H; Brattstrom-L; Boers-G; Ueland-P; Rubba-P; Palma-Reis-R; Meleady-R; Daly-L; Witteman-J; Graham-I

SO:   Circulation. 1998 Feb 10; 97(5): 437-43

AB:   BACKGROUND: A high plasma homocysteine con-centration is a risk factor for atherosclerosis, and circulating concentrations of homocysteine are related to levels of folate and vitamin B6. This study was performed to explore the interrelationships between homocysteine, B vitamins, and vascular diseases and to evaluate the role of these vitamins as risk factors for atherosclerosis. METHODS: In a multicenter case-control study in Europe, 750 patients with documented vascular disease and 800 control subjects frequency-matched for age and sex were compared. Plasma levels of total homocysteine (before and after methionine loading) were determined, as were those of red cell folate, vitamin B12, and vitamin B6. RESULTS: In a conditional logistic regression model, homocysteine concentrations greater than the 80th percentile for control subjects either fasting (12.1 micromol/L) or after a methionine load (38.0 micromol/L) were associated with an elevated risk of vascular disease independent of all traditional risk factors. In addition, concentrations of red cell folate below the lowest 10th percentile (<513 nmol/L) and concentrations of vitamin B6 below the lowest 20th percentile (<23.3 nmol/L) for control subjects were also associated with increased risk. This risk was independent of conventional risk factors and for folate was explained in part by increased homocysteine levels. In contrast, the rela-tionship between vitamin B6 and atherosclerosis was independent of homocysteine levels both before and after methionine loading. CONCLUSIONS: Lower levels of folate and vitamin B6 confer an increased risk of atherosclerosis. Clinical trials are now required to evaluate the effect of treatment with these vitamins in the primary and secondary prevention of vascular diseases.

 

 

TI:    Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. The Medical Research Council’s General Practice Research Framework

SO:   Lancet. 1998 Jan 24; 351(9098): 233-41

AB:   BACKGROUND: We aimed to evaluate low intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease (IHD). METHODS: 5499 men aged between 45 years and 69 years at high risk of IHD were recruited from 108 practices in the UK that belong to the Medical Research Council’s General Practice Research Framework. Initially, warfarin or placebo was randomly allocated to 1427 men; 1013 of these men later moved to a factorial stage of the trial, retaining their warfarin or placebo warfarin allocation and adding randomly allocated active or placebo aspirin. Another 4072 men entered directly into the factorial stage making a total of 5085 men. The four factorial treatment groups were: active warfarin and active aspirin (WA, n = 1277), active warfarin and placebo aspirin (W, n = 1268), and placebo warfarin and active aspirin (A, n = 1268), and placebo warfarin and placebo aspirin (P, n = 1272). The primary end-point was all IHD defined as the sum of coronary death and fatal and non-fatal myocardial infarction (MI). FINDINGS: The mean International Normalised Ratio (INR) of those on active warfarin was 1.47. The mean warfarin dose was 4.1 mg a day (range 0.5 mg-12.5 mg). There were 410 IHD events (142 fatal, 268 non-fatal). The main effect of warfarin (i.e., WA and W vs A and P) was a reduction in all IHD of 21% (95% CI 4-35, p = 0.02) chiefly due to a 39% reduction (15-57, p = 0.003) in fatal events so that warfarin reduced the death rate from all causes by 17% (1-30, p = 0.04). The main effect of aspirin (i.e., WA and A vs W and P) was a reduction in all IHD of 20% (1-35, p = 0.04) almost entirely due to a 32% reduction (12-48, p = 0.004) in non-fatal events. Absolute reductions in all IHD due to warfarin or aspirin were 2.6 and 2.3 per 1000 person years, respectively. WA reduced all IHD by 34% (11-51, p = 0.006) compared with P. WA increased haemorrhagic and fatal strokes. Ruptured aortic or dissecting aneurysms occurred in 15 of those who were or had been on warfarin compared with three of those who had not (p = 0.01). INTERPRETATION: These results add to evidence that aspirin reduces non-fatal IHD. Warfarin reduced all IHD chiefly because of an effect on fatal events. Combined treatment with warfarin and aspirin is more effective in the reduction of IHD than either agent on its own.

 

 

TI:    Effect of HMGcoA reductase inhibitors on stroke. A meta-analysis of randomized, controlled trials.

AU:   Bucher-HC; Griffith-LE; Guyatt-GH

SO:   Ann-Intern-Med. 1998 Jan 15; 128(2): 89-95

AB:   BACKGROUND: Stroke is a leading cause of death in the industrialized world, and hypercholesterolemia may be a risk factor for stroke. OBJECTIVE: To determine whether reducing cholesterol levels with HMGcoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors or other antilipidemic interventions reduces risk for nonfatal and fatal stroke. DATA SOURCES: A systematic search in the MEDLINE and EMBASE databases of the English-language and non-English-language literature published from 1966 through October 1996. STUDY SELECTION: All randomized, controlled trials of any cholesterol-lowering intervention that reported data on nonfatal and fatal strokes, on death from coronary heart disease, and on overall mortality were included. Whether treatment effects differed according to the type of cholesterol-lowering intervention used was investigated. DATA EXTRACTION: Trials were reviewed for methods, inclusion and exclusion criteria, and outcomes. DATA SYNTHESIS: 28 trials (for a total of 49,477 study participants in the intervention group and 56,636 participants in the control group) were included. The risk ratio for nonfatal and fatal stroke with HMGcoA reductase inhibitors was 0.76 (95% CI, 0.62 to 0.92; test of heterogeneity, P > 0.2). The risk ratios for nonfatal and fatal stroke with fibrates, resins, and dietary interventions were all close to 1.0, and the difference between the HMGcoA reductase inhibitor effect and the pooled estimate for all other interventions would, under the null hypothesis, be unlikely to occur by chance (P = 0.01). Trials with HMGcoA reductase inhibitors also showed reductions in rates of death from coronary heart disease and overall mortality. CONCLUSION: This meta-analysis of randomized, controlled trials suggests that in hyperlipidemic patients who have not previously had stroke, HMGcoA reductase inhibitors reduce the incidence of stroke.

 

 

TI:    [Factors associated to aspirin failure for secondary stroke prevention]

AU:   Chamorro-A; Blanc-R; Ascaso-C; Saiz-A; Vila-N

SO:   Med-Clin-Barc. 1997 Nov 1; 109(15): 569-72

AB:   BACKGROUND: It is not settled whether aspirin (ASA) failure may be predicted in stroke and transient ischemic attack (TIA) patients. The risk of ASA failure may be predicted by analyzing the epidemiological traits of patients with stroke or TIA. PATIENTS AND METHODS: We evaluated retrospectively 695 stroke or TIA patients admitted to the Downtown Barcelona Stroke Registry, including 54 patients who recurred while on 125-500 mg/day of ASA (group ASA failure), and 178 patients who showed a good clinical response to the same dose of ASA for at least one year of follow-up (group ASA sensitive). Vascular risk factors, stroke subtypes, and clinical and radiological findings were compared in both groups. RESULTS: On multivariate analysis ASA failure was independently correlated with history of myocardial infarction, nonvalvular atrial fibrillation or hyper-cholesterolemia. A trend toward age older than 65 was also correlated with ASA failure. On the contrary, periventricular lucencies were a protector factor. Stroke severity at clinical onset and at follow-up was unrelated to the intake of ASA at stroke onset. CONCLUSIONS: Males or females older than 65 years, with a history of coronary heart disease or atrial fibrillation, serum cholesterol level > 240 mg/dl, and a CT scan showing no evidence of small vessel disease are, respectively, the characteristics most frequently encountered in patients who suffer an ischemic stroke despite preventive treatment with 125-500 mg/day of ASA. Moreover, this treatment does not reduce initial and long-term stroke severity.

 

 

TI:    Hemostatic factors as predictors of ischemic heart disease and stroke in the Edinburgh Artery Study.

AU:   Smith-FB; Lee-AJ; Fowkes-FG; Price-JF; Rumley-A; Lowe-GD

SO:   Arterioscler-Thromb-Vasc-Biol. 1997 Nov; 17(11): 3321-5

AB:   Plasma fibrinogen is a consistent predictor of ischemic heart disease (IHD) in prospective studies, but there are fewer data relating other hemostatic variables to IHD and also to stroke. We therefore studied the relationships of plasma fibrinogen, von Willebrand factor antigen, tissue plasminogen activator (TPA) antigen, factor VII, and fibrin D-dimer to incidence of IHD and stroke and determined whether any associations could be explained by conventional risk factors and baseline heart disease. In the Edinburgh Artery study, 1592 men and women aged 55 to 74 years, randomly sampled from the general population, were followed prospectively over 5 years to detect fatal and nonfatal IHD and stroke events. During the 5 years, 268 new vascular events were identified. Baseline plasma fibrinogen was independently related to risk of stroke in multivariate analysis that adjusted for cigarette smoking, LDL-cholesterol, systolic blood pressure, and preexisting IHD (relative risk [RR] 1.52, 95% confidence interval [CI] 1.17, 1.98). TPA antigen, and fibrin D-dimer were also independently associated with risk of stroke (RR 1.69,95% CI 1.22,2.35 and RR 1.96, 95% CI 1.12,3.41, respectively). Significant relationships were found between TPA antigen and myocardial infarction (P < or = .05). In older men and women, increased coagulation activity and disturbed fibrinolysis are predictors of future vascular events (both IHD and stroke).

 

 

TI:    Preventing stroke in atrial fibrillation.

AU:   Wolf-PA; Singer-DE

SO:   Am-Fam-Physician. 1997 Dec; 56(9): 2242-50

AB: Atrial fibrillation, a common cardiac arrhythmia, is now recognized as a powerful risk factor for stroke. Previously, atrial fibrillation was thought to predispose persons to stroke only in the presence of rheumatic heart disease with mitral stenosis. The significant impact of nonvalvular atrial fibrillation on stroke incidence, recurrence and mortality was not fully appreciated. A series of clinical trials have confirmed that a five-fold increase in stroke incidence occurs in patients with atrial fibrillation, and that warfarin anticoagulation is efficacious in stroke prevention. This anticoagulation benefit was achieved with an acceptably low risk of serious hemor-rhage.

 

 

TI:    Blood pressure control and recurrence of hypertensive brain hemor-rhage.

AU:   Arakawa-S; Saku-Y; Ibayashi-S; Nagao-T; Fujishima-M

SO:   Stroke. 1998 Sep; 29(9): 1806-9

AB:   BACKGROUND AND PURPOSE: Recent studies have demon-strated that recurrence of hypertensive brain hemorrhage (HBH) is not uncommon. However, risk factors for the recurrence of HBH have not been evaluated systematically. METHODS: We analyzed 74 patients with HBH who were admitted to our clinic and followed up as outpatients for a mean of 2.8 years. Blood pressure (BP) and other clinical features were compared between the groups of patients with and without rebleeding. We determined the recurrence rate of HBH in relation to BP. RESULTS: Diastolic BP was significantly higher in the recurrence group than in the nonrecurrence group (88+/-8 versus 82+/-7 mm Hg; P=0.04). Systolic BP and other clinical variables were not different between the groups. The recurrence rate was 10.0% per patient-year in patients with diastolic BP >90 mm Hg and <1.5% in those with lower diastolic BP (P<0.001). No patients with diastolic BP <70 mm Hg experienced rebleeding. CONCLUSIONS: Higher diastolic BP was related to an increased rate of rebleeding. Diastolic BP >90 mm Hg may be regarded as a factor predictive of the recurrence of HBH.

 

 

TI:    Cholesterol, endothelial function and cardiovascular disease.

AU:   Wilkinson-IB; Cockcroft-JR

SO:   Curr-Opin-Lipidol. 1998 Jun; 9(3): 237-42

AB:   Hypercholesterolaemia is associated with endothelial dysfunction and increased risk of atheromatous disease. Although endothelial dysfunction has been demonstrated early in the course of the disease process, it remains difficult to establish a causal relationship. Despite this, endothelial function has been used as a surrogate marker in small trials to identify and assess the effectiveness of therapeutic interventions to reduce cardiovascular mortality, before large scale clinical trials are undertaken. Recently, arterial stiffness has emerged as an independent risk factor for cardiovascular disease and may provide a link between hypercholesterolaemia, endothelial dysfunction, hypertension and stroke.

 

 

TI:    Risk factors for stroke due to cerebral infarction in young adults.

AU:   You-RX; McNeil-JJ; O’Malley-HM; Davis-SM; Thrift-AG; Donnan-GA

SO:   Stroke. 1997 Oct; 28(10): 1913-8

AB:   BACKGROUND AND PURPOSE: Stroke in the young is particularly tragic because of the potential for a lifetime of disablement. More than 10% of patients with stroke due to cerebral infarction are aged 55 years or younger. While a number of studies have addressed the issue of stroke mechanism in the young, quantitation of risk factors has rarely been undertaken. Given the importance of risk factor assessment in primary prevention, we aimed to assess this using case-control methodology in a hospital-based series and community-based control subjects. METHODS: A total of 201 consecutive patients with first-onset stroke due to cerebral infarction aged 15 to 55 years (mean, 45.5 years) were accrued from four teaching hospitals during 1985 to 1992 and compared with their age- and sex-matched neighborhood controls. Infor-mation concerning potential risk factor exposure status was collected by structured questionnaire at interview. Stroke risks were estimated by calculating the odds ratios with multivariate logistic regression. RESULTS: Significantly increased risk of stroke was found among those with diabetes (odds ratio, 11.6 [95% confidence intervals, 1.2 to 115.2]), hypertension (6.8 [3.3 to 13.9]), heart disease (2.7 [1.1 to 6.4]), current cigarette smoking (2.5 [1.3, 5.0]), and long-term heavy alcohol consumption (> or = 60 g/d) (15.3 [1.0 to 232.0]). However, heavy alcohol ingestion (> or = 60 g) within 24 hours preceding stroke onset was not a risk factor (0.9 [0.3 to 3.4]). CONCLUSIONS: Diabetes, hypertension, heart disease, current smoking, and long-term heavy alcohol consumption are major risk factors for stroke in young adults. Given that the majority of these factors are either correctable or modifiable, prevention strategies may have the potential to reduce the impact of stroke in this age group.

 

 

TI:    [Detection of microemboli by transcranial Doppler sonography after carotid endarterectomy]

AU:   Akiyama-Y; Yoshimoto-H; Nagatsuka-K; Todaka-T; Nomura-M; Sawada-M; Morimoto-M; Kojima-A; Hashimoto-N

SO:   No-Shinkei-Geka. 1997 Sep; 25(9): 791-4

AB:   Transcranial Doppler sonography (TCD), a non-invasive monitoring technique, has potential for detecting microemboli caused by the extracranial internal carotid artery. Many previous reports have shown that TCD-detected microemboli may be a risk factor for stroke. The main purpose of this study is to verify whether microemboli cease after carotid endarterectomy (CEA). TCD monitoring was performed in 43 cases before and after CEA. TCD monitoring was carried out for an hour at the ipsilateral middle cerebral artery of each case using a 2-MHz pulse-wave transcranial Doppler device, and high intensity transient signals were counted as microemboli. Microemboli were detected preoperatively in 10 cases (23.3%). Microemboli were not detected in any case immediately after CEA, in either the subacute stage (from 14 to 21 days after CEA) or in the chronic stage (more than 3 months after CEA). In the acute stage (from 3 to 7 days after CEA), microemboli were detected in three cases (7.0%). The rate of TCD-detected microembolic was always significantly reduced after CEA. TCD monitoring can be helpful in assessing the effect of CEA for prevention of stroke by removing the suspected source of microemboli.

 

 

TI:    Incidence of and risk factors for atrial fibrillation in older adults.

AU:   Psaty-BM; Manolio-TA; Kuller-LH; Kronmal-RA; Cushman-M; Fried-LP; White-R; Furberg-CD; Rautaharju-PM

SO:   Circulation. 1997 Oct 7; 96(7): 2455-61

AB:   BACKGROUND: This study aimed to describe the incidence of atrial fibrillation (AF) among older adults during 3 years of follow-up. METHODS AND RESULTS: In this cohort study, 5201 adults > or = 65 years old were examined annually on four occasions between June 1989 and May 1993. At baseline, participants answered questionnaires and underwent a detailed examination that included carotid ultrasound, pulmonary function tests, ECG, and echocardiography. Subjects with a pacemaker or AF at baseline (n=357) were excluded. New cases of AF were identified from three sources: (1) annual self-reports, (2) annual ECGs, and (3) hospital discharge diagnoses. Cox proportional-hazards models were used to assess baseline risk factors as predictors of incident AF. Among 4844 participants, 304 developed a first episode of AF during an average follow-up of 3.28 years, for an incidence of 19.2 per 1000 person-years. The onset was strongly associated with age, male sex, and the presence of clinical cardiovascular disease. For men 65 to 74 and 75 to 84 years old, the incidences were 17.6 and 42.7, respectively, and for women, 10.1 and 21.6 events per 1000 person-years. In stepwise models, the use of diuretics, a history of valvular heart disease, coronary disease, advancing age, higher levels of systolic blood pressure, height, glucose, and left atrial size were all associated with an increased risk of AF. The use of beta-blockers and high levels of alcohol use, cholesterol, and forced expiratory volume in 1 second were associated with a reduced risk of AF. CONCLUSIONS: The incidence of AF in older adults may be higher than estimated by previous population studies. Left atrial size appears to be an important risk factor, and the control of blood pressure and glucose may be important in preventing the development of AF.

 

 

TI:    [Secondary prevention of stroke through arterial blood pressure reduction]

AU:   Mancia-G; Grassi-G

SO:   Cardiologia. 1997 Jul; 42(7): 715-9

AB: Large scale observational studies have conclusively demonstrated that systolic and diastolic blood pressure values are linearly related to the incidence of cerebro-vascular diseases and that high blood pressure is an important risk factor for both primary and secondary development of stroke. Interventional studies have shown that blood pressure lowering by antihypertensive treatment reduces the incidence of stroke in hyper-tensive patients without a history of previous stroke. Whether this is the case also for the secondary prevention of cerebral ischemic attacks has not been unequivocally shown, however. The PROGRESS (“Perindopril Protection Against Recurrent Stroke Study”) study has been designed and is under way to collect information on this important issue of the antihypertensive treatment, its purpose being to evaluate the blood pressure lowering effects with an ACE-inhibitor on recurrent stroke in an overall population of 6000 patients with a positive history of previous cerebral ischemic attacks or stroke.

 

 

TI:    New drugs and clinical trials in diabetes and hypertension.

AU:   Nilsson-P

SO:   Exp-Clin-Endocrinol-Diabetes. 1997; 105 Suppl 2: 64-9

AB:   Hypertension is a well-established risk factor for cerebro-cardiovascular disease in diabetics, as well as for progressing renal disease. Several pathophysiological mechanisms link hypertension with non-insulin-depen-dent diabetes (NIDDM), e.g. insulin resistance. This will be discussed below as regards pathophysiology and treatment possibilities, especially with new drugs in ongoing clinical trials.

 

 

TI:    A strategy for arterial risk assessment and management in type 2 (non-insulin-dependent) diabetes mellitus. European Arterial Risk Policy Group on behalf of the International Diabetes Federation European Region.

SO:   Diabet-Med. 1997 Jul; 14(7): 611-21

AB:   People with Type 2 (non-insulin-dependent) diabetes mellitus die mainly from cardiovascular and cerebro-vascular disease. Furthermore, the major burden of their symptoms arise from arterial disease, including peripheral vascular disease. However, management guidelines for Type 2 diabetes continue to focus on blood glucose control, which is only one of a number of arterial risk factors found with this type of diabetes. Clinically it is evident that blood glucose control continues to occupy centre-stage in the management of Type 2 diabetes as practised by many physicians. Even when arterial risk factors such as smoking or raised serum triglycerides are noted, their management is often relatively neglected. As part of the St Vincent Declaration Action Programme, a working group has sought consensus on the number and relative importance of arterial risk factors requiring management in quality diabetes care. The group seeks to assist those devising protocols and guidelines, records and quality systems, and those charged with directly advising and educating people with diabetes. Arterial risk factors that can be routinely identified and monitored, and modified by application of management protocols, include high blood pressure, high serum total and LDL cholesterol, low serum HDL cholesterol and raised serum triglycerides, poor blood glucose control, smoking, high body mass index and body fat distribution. Aspirin can modify hypercoagulability, but this is not easily monitored. Arterial risk factors that cannot be modified, but which have an impact on the intensity of mana-gement of other factors, include ethnic group, gender, and family history of arterial disease. Raised albumin excretion is an arterial risk factor and can be modified, but it is not clear whether this reduces cardiovascular risk. For many of the risk factors, levels of high, medium, and low risk can be set. These can be used, in consultation with the patient, to determine appropriate interventions and provide feedback on risk reduction resulting from successful management.

 

 

TI:    Current status on new anticoagulant and antithrombotic drugs and devices [see comments]

AU:   Walenga-JM; Fareed-J

SO:   Curr-Opin-Pulm-Med. 1997 Jul; 3(4): 291-302

AB:   Several new drugs for the management of thrombo-embolic disorders have recently become available. Low-molecular-weight heparins are being evaluated for the prophylaxis of medical and surgical deep venous thrombosis and pulmonary embolism; for the treatment of pre-existing thrombosis; and for cases of coronary syndrome (unstable angina, myocardial infarction), thrombotic and ischemic stroke, interventional cardio-logy, pregnancy, cancer, and transplantation-associated thrombosis. A chemically synthesized heparin penta-saccharide, which has purely anti-factor Xa activity and does not induce thrombocytopenia, is also in clinical trial. Thrombin inhibitors, such as hirudin and argatroban, are a practical anticoagulant substitute where heparin cannot be used. They are also useful for the management of coronary syndrome and as adjunct therapy. The anti-platelet agent ticlopidine and its analogue, clopidogrel, which does not produce blood dyscrasia, are effective for the secondary prevention of thrombotic stroke and the management of combined arterial thrombotic syndromes. Glycoprotein-targeting antibodies, synthetic derivatives, and peptides (some of which are orally bioavailable) have added a new dimension to the management of arterial thrombosis and high-risk patients having angioplasty. Plasma-derived agents, such as antithrombin III, are available for the management of thrombophilia and disseminated intravascular coagu-lation. Compression devices and the foot pump, alone and in combination with pharmacologic agents, have been used successfully. Combination therapy using various agents in different proportions have also been found useful. Although there is much enthusiasm in this quickly developing area and clinical trials are demon-strating the antithrombotic efficacy of the new drugs, safety considerations require additional clinical validation. Long-term outcomes and costs also need to be addressed objectively.

 

 

TI:    Atrial fibrillation and stroke: elucidating a newly discovered risk factor.

AU:   Giardina-EG

SO:   Am-J-Cardiol. 1997 Aug 28; 80(4C): 11D-18D; discussion 35D-39D

AB:   Atrial fibrillation is the most common sustained arrhythmia reported in the United States; an estimated 1-2 million Americans have chronic nonvalvular atrial fibrillation. This disorder is associated with a substantial risk of stroke. Several recent studies provide evidence that anticoagulation therapy is indicated for stroke prevention in patients with nonvalvular atrial fibrillation after recovery from a minor stroke. Clinical and echo-cardiographic criteria help to identify those patients who are at especially high risk for thromboembolic stroke and are candidates for carefully controlled anticoagulation. In an effort to reduce the possibility of thromboembolic events following either chemical or electrical cardio-version, the American College of Chest Physicians has recently prepared guidelines for the use of anti-coagulation in the conversion of atrial fibrillation. The efficacy of antiarrhythmic drug therapy for cardioversion is often difficult to assess. Furthermore, it is associated with major risks, including heart failure and exacerbation of arrhythmia, and minor risks, including systemic intolerance. A new National Institutes of Health trial, Atrial Fibrillation Follow-up Investigation of Rhythm Mana-gement (AFFIRM), will clarify the true risks and benefits of antiarrhythmic therapy for conversion of atrial fibrillation to sinus rhythm. Patients who cannot tolerate drug therapy may benefit from interruption of conduction in the bundle of His, followed by implantation of a permanent pacemaker, the use of radiofrequency energy ablation, or the implantation of an atrial defibrillator. Some patients may benefit from surgical procedures, such as left atrial isolation, the corridor operation, and the maze operation.

 

 

TI:    Identification and management of stroke risk in older people: a national survey of current practice in primary care.

AU:   Coppola-WG; Whincup-PH; Walker-M; Ebrahim-S

SO:   J-Hum-Hypertens. 1997 Mar; 11(3): 185-91

AB: The current practice of stroke prevention was assessed among UK general practitioners (GPs) using a postal questionnaire. A random sample of 583 GPs (response rate 60%) in practice throughout the UK was examined. Main outcomes were the reported practice in the identification of stroke risk, management of hypertension, and use of other interventions (particularly aspirin treatment) to reduce the risk of stroke. Most respondents (451, 77%) reported that they specifically identified patients at high risk of stroke. However, of these only 301 (67%) used more than one major risk factor to do this and less than one-third used either age or pre-existing cardiovascular disease as an indicator. Thresholds for drug treatment of hypertension increased markedly with patient age with only 68%, 23% and 9% of respondents reporting treating elevated systolic, diastolic and isolated systolic pressures respectively, in accord with the British Hypertension Society (BHS) guidelines for patients aged 70-79 years. Thresholds for blood pressure (BP) treatment in older patients did not differ by region but were higher among respondents who had been in general practice for more than 10 years. The value of aspirin in preventing stroke in patients with pre-existing cardiovascular disease was recognized by almost all (560, 96%) respondents. The results suggest that there is scope for increasing the benefits of stroke prevention in primary care, by focusing on the management of patients at high absolute risk, in whom the greatest treatment benefits are likely to be obtained.

 

 

TI:    Status of lipids as a risk factor for stroke.

AU:   Gorelick-PB; Schneck-M; Berglund-LF; Feinberg-W; Goldstone-J

SO:   Neuroepidemiology. 1997; 16(3): 107-15

AB:   There is mounting epidemiologic evidence to support the relationship of lipids as a risk factor for ischemic stroke. We review epidemiologic and patho-physiologic evidence for such a link. Treatment of hyperlipidemia is addressed within the context of overall cardiovascular disease risk but also for stroke prevention.

 

 

TI:    The global epidemiology of non-insulin-dependent diabetes mellitus and the metabolic syndrome.

AU:   Zimmet-PZ; McCarty-DJ; de-Courten-MP

SO:   J-Diabetes-Complications. 1997 Mar-Apr; 11(2): 60-8

AB:   Non-insulin-dependent diabetes mellitus (NIDDM) constitutes about 85% of all cases of diabetes in developed countries and it has now reached epidemic proportions in many developing nations, as well as disadvantaged groups in developed countries, e.g., Mexican- and African-Americans and Australian Aborigines and Torres Strait Islanders. The diagnosis of NIDDM is usually made after the age of 50 years in Europids, but it is seen at much younger age in these high prevalence populations, which also include Pacific Islanders, Native Americans, and migrant Asian Indians and Chinese. There is enormous variation in NIDDM prevalence between populations, and exceptionally high rates have been documented in populations who have changed from a traditional to a modern lifestyle, e.g., American Pima Indians, Micronesians, and other Pacific Islanders, Australian Aborigines, migrant Asian Indians, and Mexican-Americans. Over the next decade, following the initial phase of the NIDDM epidemic, macro- and microvascular complications will emerge as a major threat to future public health throughout the world with huge economic and social costs. The major cause of death in NIDDM is macrovascular disease (coronary artery, peripheral vascular, and cerebrovascular), which accounts for at least two-thirds of NIDDM mortality. A key strategy in reducing macrovascular disease lies in the better understanding of the Deadly Quartet or Metabolic Syndrome. New data suggest that hyperleptinemia rather than hyper-insulinemia may play an important and central role in the genesis of the cardiovascular disease risk factor cluster that constitutes the Metabolic Syndrome.

 

 

TI:    Hypertension and borderline isolated systolic hypertension increase risks of cardiovascular disease and mortality in male physicians.

AU:   O’Donnell-CJ; Ridker-PM; Glynn-RJ; Berger-K; Ajani-U; Manson-JE; Hennekens-CH

SO:   Circulation. 1997 Mar 4; 95(5): 1132-7

AB:   BACKGROUND: The objective of this study was to examine whether definite hypertension and borderline isolated systolic hypertension predict subsequent cardiovascular disease and mortality. METHODS AND RESULTS: This was a prospective cohort study with a mean follow-up of 11.7 years. The subjects were a group of 18,682 apparently healthy US men, aged 40 to 84 years, participating in the Physicians’ Health Study, a randomized trial of low-dose aspirin and beta-carotene. The main outcome measures were total cardiovascular disease, myocardial infarction, stroke, cardiovascular death, and all-cause mortality. Hypertension was associated with substantially increased risks of total cardiovascular disease (relative risk [RR] 1.92; 95% confidence interval [CI], 1.70 to 2.18), myocardial infarction (RR,1.78; 95% CI, 1.49 to 2.13), stroke (RR, 2.19; 95% CI, 1.78 to 2.69), and cardio-vascular death (RR, 2.10; 95% CI, 1.68 to 2.63). Borderline isolated systolic hypertension was associated with significantly increased risks of cardiovascular disease (RR, 1.32; 95% CI, 1.09 to 1.59), stroke (RR, 1.42; 95% CI, 1.04 to 1.93), and cardiovascular death (RR, 1.56; 95% CI, 1.13 to 2.15), as well as a possible but non-significant increased risk of myocardial infarction (RR, 1.26; 95% CI, 0.95 to 1.67). Hypertension and borderline isolated systolic hyper-tension were associated with significantly increased risks of 41% and 22%, respectively, for all-cause mortality. CONCLUSIONS: Hypertension as well as borderline isolated systolic hypertension are associated with elevated risks of cardiovascular diseases, especially stroke and cardio-vascular death. Hypertension is associated with an increased risk of myocardial infarction, and borderline isolated systolic hypertension predicts a possible but more modest increase in risk. These data add to the existing evidence that hypertension is a major cardiovascular risk factor and extend the findings to borderline isolated systolic hypertension.

 

 

TI:    Status of risk factors for dementia associated with stroke.

AU:   Gorelick-PB

SO:   Stroke. 1997 Feb; 28(2): 459-63

AB:   BACKGROUND: Cognitive impairment associated with vascular disease may be the only preventable form of dementia of late life. Identification of risk factors for dementia associated with stroke may be a prelude to improved intervention. SUMMARY OF REVIEW: I reviewed putative risk factors for dementia associated with stroke. These included demographic, atherogenic, stroke-related, and genetic factors. Key studies from the English literature were reviewed and graded according to quality of evidence ratings (classes I, II, and III). Although many of the cardiovascular disease risk factors are logical antecedents of dementia associated with stroke, age was the only factor that could be considered a well-documented risk factor. CONCLUSIONS: We should continue to support efforts directed at primary stroke prevention and the brain-at-risk and predementia stages. Additional rigorous epidemiological study is needed to clarify risk factors for dementia associated with stroke.

 

 

AU:   O’Brien AA, Rajkumar C, Bulpitt CJ

AD:   Southend Hospital, Southend, Essex, UK.

TI:    Blood pressure lowering for the primary and secondary prevention of stroke: treatment of hypertension reduces the risk of stroke.

SO:   J Cardiovasc Risk. 1999 Aug. 6(4). P 203-5.

MH: Antihypertensive Agents:*TU. Blood Pressure:*DE. Hyper-tension:CO/*DT/PP. Primary Prevention:*MT. Risk Factors. Check Tags: Human.

AB:   Hypertension is the most important risk factor in the development of stroke. It is also the risk factor most amenable to treatment. The results from 18 controlled trials show a reduction in relative risk of stroke of 25-47% among treated hypertensive patients. This reduction applies both to the elderly and to younger patients, but the absolute reductions are greater among the elderly and the number of patients with hypertension that need to be treated to prevent a stroke is lower in the elderly because they have a higher risk of stroke. The reductions in relative but not absolute risk appear to be similar for both isolated systolic hypertension and combined systolic and diastolic hypertension in the elderly. The case for antihypertensive treatment in the secondary prevention of stroke is less clear but the results of four clinical trials of antihypertensive treatment among patients with and without hypertension and a history of cerebrovascular disease point to a probable benefit. The results of the PROGRESS trial will elucidate this further.

 

 

AU:   Koudstaal PJ

AD:   Department of Neurology, University Hospital Rotterdam, 40, Dr. Molewaterplein, 3015 GD Rotterdam, The Netherlands. koudstaal@ neur.azr.nl

TI:    Stroke prevention: which drugs to use and when?

SO:   J Neurol. 1999 Sep. 246(9). P 753-7.

MH: Anticoagulants:*TU.Check Tags: Animal.. Human.

AB:   This review summarizes recent findings from clinical trials regarding the prevention of stroke and translates these into therapeutic guidelines. A distinction is made between patients with previous cerebrovascular disease and those without, and between patients with and those without atrial fibrillation. Although the efficacy of aspirin is disappointingly small, the effects are consistent in all subgroups of patients with confirmed vascular disease, and this treatment remains superior as first choice except in patients with both atrial fibrillation and vascular risk factors, for whom oral anticoagulants are the optimal treatment.

 

 

AU:   O’Brien AA, Rajkumar C, Bulpitt CJ

AD:   Southend Hospital, Southend, Essex, UK.

TI:    Blood pressure lowering for the primary and secondary prevention of stroke: treatment of hypertension reduces the risk of stroke.

SO:   J Cardiovasc Risk. 1999 Aug. 6(4). P 203-5.

MH: Antihypertensive Agents:*TU. Blood Pressure:*DE. Hyper-tension:CO/*DT/PP. Primary Prevention:*MT. Risk Factors. Check Tags: Human.

AB:   Hypertension is the most important risk factor in the development of stroke. It is also the risk factor most amenable to treatment. The results from 18 controlled trials show a reduction in relative risk of stroke of 25-47% among treated hypertensive patients. This reduction applies both to the elderly and to younger patients, but the absolute reductions are greater among the elderly and the number of patients with hypertension that need to be treated to prevent a stroke is lower in the elderly because they have a higher risk of stroke. The reductions in relative but not absolute risk appear to be similar for both isolated systolic hypertension and combined systolic and diastolic hypertension in the elderly. The case for antihypertensive treatment in the secondary prevention of stroke is less clear but the results of four clinical trials of antihypertensive treatment among patients with and without hypertension and a history of cerebrovascular disease point to a probable benefit. The results of the PROGRESS trial will elucidate this further.

 

 

AU:   Sachdev GP, Ohlrogge KD, Johnson CL

AD:   Rockford Veterans Affairs Primary Care Clinic, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.

TI:    Review of the Fifth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy: outpatient management for adults.

SO:   Am J Health Syst Pharm. 1999 Aug 1. 56(15). P 1505-14.

MH: Anticoagulants:AE/*TU. Fibrinolytic Agents:AE/*TU. Outpatients:*. Thrombosis:*DT. Warfarin: AE/*TU. Adult. Aged. Association. Cardiovascular Diseases:DT. Middle Age. Check Tags: Human.

AB:   The recommendations of the Fifth American College of Chest Physicians (ACCP) Consensus Conference on Antithrombotic Therapy are reviewed, with a focus on outpatient anticoagulation management in adults. Numerous therapeutic recommendations have changed since the Fourth ACCP Consensus Conference on Antithrombotic Therapy. The system of grading recommendations has been modified to emphasize clinically important differences and to take into account the benefit-risk ratio of each treatment option. The International Normalized Ratio (INR) goal is now expressed as a specific target value within a range rather than simply an INR range. The recommendations of the fifth conference cover initiation of warfarin therapy, hemorrhagic complications, management of excessive anticoagulation, interruption of warfarin therapy for patients requiring surgery, nonvalvular atrial fibrillation, cardioversion in patients with atrial fibrillation, valvular heart disease, mechanical and biological prosthetic heart valves, coronary artery disease, saphenous vein and internal mammary artery bypass grafts, peripheral arterial occlusive disease, prevention of venous thromboembolism, treatment of venous thromboembolism, stroke prevention in patients with cerebrovascular disease, and pregnancy. Since the fourth consensus conference, new anticoagulation therapies and indications have emerged; the recommendations of the Fifth ACCP Consensus Conference on Antithrombotic Therapy have provided practitioners with a resource of immense value.

 

 

AU:   S_anchez-P_erez RM, Molt_o JM, Medrano V, Beltr_an I, D_iaz-Mar_in C

AD:   Servicio de Neurolog_ia, Hospital General Universitario de Alicante, Espa~na.

TI:    [Atherosclerosis and brain circulation]

MH:  Atherosclerosis:CO/*DI/ET. Brain:*BS. Engraving and Engravings. Hemodynamics. Lipoproteins, LDL Cholesterol:BL. Check Tags: Human.     AB:   INTRODUCTION: Atherosclerosis affects the vascular system in a diffuse way and its is clearly implicated in some of the most prevalent diseases in western countries such as cerebrovascularand cardiovascular diseases. Knowing more about the underlying pathogenic mechanisms may contribute to a better understanding of this entities and the development of therapies for both its treatment and prevention. DEVELOPMENT: We review herein the concepts included in the term atherosclerosis, the growth of the atheromatous plaque and its complications and the cellular mechanisms which intervene in its development. We analyze how it influences brain hemodynamics and its implication in cerebrovascular ischemic disease paying attention to the dissimilarities with other vascular territories and the clinical syndromes which derive from its development on different vascular structures. CONCLUSIONS: Under the concept of ischemic cerebrovascular disease we can find a group of heterogeneous clinical syndromes, usually associated to different etiopathogenic mechanisms: cardioembolic, atherothrombotic or hemodynamic. Although their risk factors may be common, these processes are clearly different form each other. Therefore including ischemic brain infarctions all together without attending to their etiology may produce important methodological biases when interpreting the results in clinical trials or other studies, and may also be a suitable explanation for differences between authors.

 

 

Превенция на наркомании

 

TI:    Applying multilevel analytic strategies in adolescent substance use prevention research.

AU:  Palmer-RF; Graham-JW; White-EL; Hansen-WB

SO:  Prev-Med. 1998 May-Jun; 27(3): 328-36

AB:  BACKGROUND: School-based drug prevention programs have been criticized on methodologic grounds because the unit of analysis is often not the unit of randomization, thus increasing the likelihood of Type I errors. Application of multilevel analytic strategies appropriately corrects this biasing tendency. This study demonstrates the practical use of such analysis. METHODS: Data from 2,370 seventh-grade students participating in a substance use prevention trial were analyzed using a multilevel strategy. We examined the effectiveness of a social pressure resistance training and a normative education (NORM) intervention against an information-only control group. RESULTS: The NORM condition revealed 1-year program effects for cigarette and marijuana use with individuals as the unit of analysis and only marginal effects with classroom as the unit of analysis. No program effects were found using school as the analysis unit. A multilevel strategy revealed program effects for cigarettes and marijuana with both class and school as grouping levels. The effect for alcohol use was significant at the 2-year follow-up. CONCLUSIONS: Interventions establishing conservative drug use norms in classrooms may be an effective strategy in reducing substance use onset among adolescents. Utilization of appropriate analytic strategies is important in the analysis and interpretation of data containing nested structures.

 

 

TI:    Adolescent school failure: failure to thrive in adolescence.

AU:  Reiff-MI

SO:  Pediatr-Rev. 1998 Jun; 19(6): 199-207

AB:  The role of the primary clinician in dealing with school failure can be critical by linking the epidemiological with the clinical and encompassing the pediatric/adolescent life span. It includes components of social and public health advocacy, preventive medicine, evaluation, education, treatment, and referral. The most effective interventions are early and multifaceted. The primary care role includes: community advocacy; counseling about prenatal drug and alcohol abuse; early detection and treatment for attentional disorders, underachievement, and learning disabilities; interviews addressing multiple risk factors, grades, school attitudes, behavior, and friends; anticipatory guidance; education about individual learning style and good “learning hygiene”; early referral and intervention for preadolescent conduct problems and parent-child conflict; early referrals for family distress; and prevention of substance abuse and adolescent pregnancy.

 

 

TI:    HIV infection and high risk behavior among patients attending an STD referral clinic in Prague, Czech Republic.

AU:  Mikl-J; Sudar-Z; Smith-PF; Bruckova-M; Jedlicka-J; Kastankova-V; Tryzna-R; DeHovitz-J

SO:  Sex-Transm-Infect. 1998 Apr; 74(2): 128-30

AB:  OBJECTIVE: This survey was conducted to determine the prevalence of HIV infection and associated risk behaviour in a high risk population of clients attending an STD clinic in Prague, Czech Republic. METHODS: Between September 1994 and January 1995, clients entering the Apolinar STD clinic in Prague, Czech Republic, were enrolled in a blinded, unlinked HIV antibody seroprevalence study. Non-identifying demographic characteristics, STD diagnoses, HIV risk exposures, and voluntary HIV testing experience were extracted from medical charts. RESULTS: Of 1394 patients for whom serum was available for testing, one was positive for HIV (HIV prevalence 0.07%, 95% confidence interval (CI) 0.01, 0.41%). This person was one of 28 men having sex with men (MSWM) (HIV prevalence among MSWM 3.6%, 95% CI 0.6, 17.7%). Among the 775 male clients, 75.5% had heterosexual unprotected sex, 11.1% had sex with high risk partners or prostitutes, 3.6% were MSWM, 1.0% were injecting drug users (IDUs), 0.7% were both MSWM and IDUs, and 6.8% and 1.8% had other or no recognized risk for HIV/STDs, respectively. Among the 619 female clients, 74.5% had heterosexual unprotected sex, 11.6% were prostitutes, 7.8% had sex with high risk partners, 1.1% were IDUs, and 3.9% and 2.3% had other or no recognised risk, respectively. The 304 adolescent patients (age 11-19 years) differed significantly (p < 0.05) in risk behaviour and STD diagnoses from the 1090 patients who were 20 years and older. Adolescents were significantly more likely to be female (58.6% v 40.5%, OR = 2.1), IDUs (3.6% v 0.4%, OR = 10.2), prostitutes (8.9% v 4.7%, OR = 2.0), and have sex partners with STDs (7.6% v 4.4%, OR = 1.8). The adolescent patients were also significantly more likely to be diagnosed with gonorrhoea (21.1% v 12.3%, OR = 1.9) and non-gonococcal urethritis (27.6% v 17.2%, OR = 1.8), and significantly less likely to have been tested previously for HIV (19.1% v 31.9%, OR = 0.5). CONCLUSIONS: HIV infection is currently uncommon in this population. However, the high rates of unprotected sex, prostitution, injecting drug use, and STDs, especially among adolescents, provide the basis for an epidemic in this population. Aggressive prevention education should be started before adolescence.

 

 

TI:    Being real and being realistic: chemical abuse prevention, teen counselors, and an ethic of care.

AU:  Dorsch-NG

SO:  J-Drug-Educ. 1997; 27(4): 335-48

AB:  Despite the national goal of “drug-free” schools, recent data suggest that chemical abuse among school-aged children remains a concern. This qualitative case study presents a “unique case” within one school’s substance abuse prevention program. In this program, pioneered in 1973, pairs of teen counselors “adopt” a middle school classroom and make regularly scheduled visits to conduct chemical abuse prevention sessions. Two of the teen counselors were perceived by both themselves and the faculty advisor as unlike other teen counselors. This study explores themes surrounding how they viewed their mission and carried it out. Two themes emerged as significant. These particular teen counselors saw both their role and their mission as being “real” and being “realistic.” This perspective represents a concrete expression of the ethic of care described by Nel Noddings. It is a perspective which should be considered in developing teen counselor programs or any chemical abuse prevention program.

 

 

TI:    Risk and protective factors as predictors of adolescent alcohol involvement and transitions in alcohol use: a prospective analysis.

AU:  Scheier-LM; Botvin-GJ; Baker-E

SO:  J-Stud-Alcohol. 1997 Nov; 58(6): 652-67

AB:  OBJECTIVE: Determinants of initial alcohol use may differ from predictors of accelerated or problematic consumption. Social influences may be strong predictors of initial drinking; however, later stages of problem drinking may be linked developmentally to intrapersonal deficits. This study prospectively examined the influence of chronic and changing risk and protective status in predicting adolescent alcohol involvement and transitions in alcohol use. METHOD: Data were obtained from a three-wave cohort (N = 823) of 8th-10th grade nonintervention students participating in a school-based drug abuse prevention trial. Cognitive, attitudinal and social influence measures were dichotomized using empirical cut-offs to designate risk or protective status. Using a conceptually based assignment scheme, additive risk indices were created assessing chronic (averaging across time) and changing features of competence, psychological and interpersonal functioning, cognitive-affective and social influences. Three chronic and change protective indices were created tapping competence, psychological, and interpersonal functioning. RESULTS: Controlling for initial drinking and gender, chronic risk for social influence and psychological functioning and increased risk for social influences and competency predicted subsequent drinking behavior. Chronic psychological protection attenuated subsequent drinking. Using categorical measures of drinking behavior to designate nonuse, experimental or moderate-heavy use, chronic social influence and competency risk were associated with an increased likelihood of accelerated drinking, whereas improved psychological functioning diminished the likelihood of increased drinking behavior. CONCLUSIONS: Findings underscore the need for implementing prevention strategies that reinforce developmentally appropriate skills and enhance personal competence and psychological functioning as effective barriers against initial and more problematic alcohol use. The unique contribution of protective forces also underscores that risk reduction and protection enhancement are complementary processes and are both required to offset social influences for alcohol consumption.

 

 

TI:    One year outcome evaluation of an alcohol and drug abuse prevention program in a Quebec high school.

AU:  Ross-C; Richard-L; Potvin-L

SO:  Can-J-Public-Health. 1998 May-Jun; 89(3): 166-70

AB:  This article presents the results of a one-year outcome evaluation of a school-based alcohol- and drug-abuse prevention program targeting adolescents in Quebec. This evaluation concerns the school component of the program and includes the first seven classroom interventions. The design is a pre- and post-intervention assessment of both the experimental (n = 145 students) and the control school (n = 179 students). Results obtained do not reveal any significant effect of the program on knowledge and beliefs regarding the use of alcohol and drugs, or any modification in self-efficacy with respect to decision making and ability to resist external pressure concerning the decision to use marijuana/hashish. The results do show, however, a decrease among the exposed students in self-efficacy within the context of alcohol use. Such a result may be a consequence of the program’s capacity to raise the students’ level of awareness of their susceptibility to social influences. It is plausible that in order to have positive effects, classroom interventions such as the present one need to be supplemented by additional activities targeting youths’ environment.

 

 

TI:    Background to crack cocaine addiction and HIV high-risk behavior: the next epidemic.

AU:  Word-CO; Bowser-B

SO:  Am-J-Drug-Alcohol-Abuse. 1997 Feb; 23(1): 67-77

AB:  BACKGROUND: Increasing rates of sexually transmitted diseases among users of noninjection drugs prompt speculation that crack cocaine users who do not inject are at particularly high risk of HIV (human immunodeficiency virus) infection. METHODS: A street recruitment technique was employed to enroll 331 primarily African-American men aged 18-29 in an area of San Francisco where crack cocaine is sold openly. One-half were regular crack users and the other half had never used the drug. Few reported injection drug use or male-to-male sex. In a face-to-face interview, participants reported on their drug use, knowledge of HIV, sexual practice, condom use, and demographic characteristics. Following counseling, each was tested for HIV and syphilis. RESULTS: Comparisons showed that demographically similar, crack users reported more sexual partners in the last 12 months, more sexually transmitted diseases (STDs) in their lifetime, and greater frequencies of paying for sex, exchanging sex for drugs, and having sex with injection drug users. Users reported greater current depression, anxiety, and social isolation. They reported earlier initiation into alcohol use and less positive parenting experiences during their adolescence. CONCLUSION: These results are consistent with findings that report the comorbidity of drug abuse and mental illness. Implications are drawn for reducing HIV infection among this high-risk population for early adolescent, community mental health, and substance abuse treatment programs.

 

 

AU:   Laviola G, Adriani W, Terranova ML, Gerra G

AD:   Section of Behavioural Pathophysiology, Labor. F.O.S., Istituto Superiore di Sanit_a, Rome, Italy. laviola@iss.it

TI:    Psychobiological risk factors for vulnerability to psychostimulants in human adolescents and animal models.

SO:   Neurosci Biobehav Rev. 1999 Nov. 23(7). P 993-1010.

AB:   Adolescence is associated with an increased risk of developing drug abuse/dependence. During this ontogenetic phase, brain and hormonal systems are still undergoing crucial maturational rearrangements, which take place together with significant modifications in psychosocial development. However, the neurohormonal and behavioral facets of adolescence have been poorly investigated in relation to the vulnerability to psychostimulants such as MDMA (“Ecstasy”) and amphetamine (AMPH). Novelty-seeking, a temperamental/behavioral trait that is typical of this age period, might substantially contribute to both psychological and psychobiological vulnerability. In humans, an elevated score of novelty-sensation seeking and a derangement of monoaminergic function were both associated with late adolescence MDMA users compared to controls. In animal models of periadolescence, the search for novel stimuli and sensations actually shares a common neurobiological substrate (the reward-related brain mesolimbic pathways) with psychostimulants. The present review summarises recent work in mice, which indicates that periadolescent subjects are characterized by an unbalanced and “extremes-oriented” behavior and by elevated novelty-seeking compared to adults. Repeated and intermittent administration of cocaine or AMPH was associated with the development of a prominent locomotor sensitization in periadolescents, which failed to exhibit the marked sensitization of the stereotyped behavioral syndrome—possibly associated with poor welfare—that was typical of adults. A unique profile of integrated behavioral and physiological hyporesponsivity to both forced novelty and acute AMPH administration during periadolescence was also found. As a whole, these results, together with previous work on this topic, suggest that periadolescents may be more “protected” from AMPH-related aversive properties, and perhaps more vulnerable to the experience of internal states of reward, than older animals. Thus, the present animal model of adolescence seems to represent a reliable and useful method for the investigation of vulnerability to a variety of habit-forming agents or emotional experiences whose positive reinforcing properties may rely on common neurobiological substrates. A deeper understanding of psychostimulant effects during adolescence on the complex interaction between genetic, neurobiologic, psychosocial, and environmental factors will lead to earlier and more effective prevention and treatment.

 

 

AU:   Barrett ME, de Palo MP

AD:   Department of Social Work and Psychology, National University of Singapore, Republic of Singapore.

TI:    Community-based intervention to reduce demand for drugs in Northern Thai tribal villages.

SO:   Subst Use Misuse. 1999 Nov. 34(13). P 1837-79.

MH: Developing Countries:*. Health Education:*. Heroin Depen-dence:PC/*RH. Opioid-Related Disorders:PC/*RH. Opium:*. Rural Population:*. Community Mental Health Services. Drug and Narcotic Control. Knowledge, Attitudes, Practice. Medicine, Traditional. Thailand. Check Tags: Human.

AB: This is an evaluation study of a community-based intervention model used in a project designed to reduce the demand for and use of opium, heroin, and other drugs among 85 tribal villages located in Northern Thailand. The Integrated Drug Abuse Prevention (IDAP) Project was conducted from 1995 to 1997 and used a community-based approach which included innovative methods such as multimedia awareness raising campaigns, networking between villages and local government agencies, and village-based drug detoxification and treatment to assist villages in solving their drug problems. The intervention model was successfully implemented in most villages and demonstrated very good results in improving awareness, decreasing the number of active drug users living in the villages, and preventing new cases of addiction. However, a follow-up study at 6 months after project termination indicated problems with sustainability of demand reduction activities and outcomes. These problems were attributed in part to a lack of empowerment among village leaders to continue activities without assistance from project staff. Also, village leaders expressed problems in resisting drug dealers who returned to the area, which suggested that support from law enforcement is critical to the viability of drug demand reduction programs.

 

 

AU:   Barnard-Thompson K, Leichner P

AD:   Kingston Psychiatric Hospital, Ontario.

TI:    Psychiatric residents’ views on their training and experience regarding issues related to child abuse.

SO: Can J Psychiatry. 1999 Oct. 44(8). P 769-74.

MH: Attitude of Health Personnel:*. Child Abuse:*PX/SN. Child Abuse, Sexual:*PX/SN. Internship and Residency:*. Psychiatry:*ED. Adult. Awareness. Child. Hamsters. Middle Age. Risk Factors. Check Tags: Animal..  Female..  Human..  Male.

AB: OBJECTIVE: To explore the views of psychiatric residents regarding the prevalence and impact of child physical, sexual, and emotional abuse; the adequacy of their training in these areas; and the sufficiency of treatment resources for abused children and their abusers. METHOD: A 97-item survey questionnaire was distributed to 189 psychiatric residents as a section of the 1997 Coordinators of Postgraduate Education (COPE) self-assessment examination. RESULTS: Estimations of prevalence of child sexual, physical, and emotional abuse among men and women in both general and psychiatric populations were generally accurate according to the literature. Residents appeared to be aware of the multifactorial nature of child abuse and identified the particular importance of social-environmental factors such as parental drug abuse and a violent social environment. Residents also recognized the significant association of posttraumatic stress disorder, borderline personality disorder, and dissociative disorders with child sexual abuse. Seventy-five percent of respondents felt that instruction on the topic of child abuse during their psychiatric residency was insufficient. Sixty-four percent of respondents felt that resources for the treatment of effects of child abuse were insufficient; 83% felt that treatment resources for child abusers were insufficient. CONCLUSION: Although psychiatric residents appear to be aware of the prevalence of child abuse and its varied effects on the victims’ mental health, the majority felt that their medical training in this area had been insufficient. For this reason, medical school curricula and training experiences might require reevaluation. Increasing the profile of child abuse and its impact on mental health might also result in enhanced prevention programs and treatment resources available to abused children and their abusers.
** Full text is available **

 

 

AU:   Obot IS, Anthony JC

AD:   Johns Hopkins University, Baltimore, MD 21205, USA.

TI:    Association of school dropout with recent and past injecting drug use among African American adults.

SO:   Addict Behav. 1999 Sep-Oct. 24(5). P 701-5.

MH: Blacks:*PX. Student Dropouts:*. Substance Abuse, Intravenous:*

PX. Adolescence. Adult. Cross-Sectional Studies. Retrospective Studies. Time Factors.

Check Tags: Female..  Human..  Male..  Support, U.S. Gov’t, P.H.S..

AB: We hypothesized that, among African American adults, starting and maintaining injecting drug use (IDU) would be associated with dropping out of high school, and that starting and stopping IDU would be associated with earning the general equivalency diploma (GED) after school dropout. Drawn from the 1991-1993 National Household Surveys on Drug Abuse (NHSDA), the nationally representative sample of African Americans consisted of 117 recent and 109 past IDUs. Conditional multiple logistic regression was used to estimate the hypothesized associations. African American high school dropouts and GED holders were 2-3 times more likely to have started and maintained IDU, as compared to high school graduates. Earning the GED was associated with starting and then stopping IDU. These findings merit further investigation because they might have significant public health implications for the prevention of IDU among African Americans.

 

 

AU:   Lynam DR, Milich R, Zimmerman R, Novak SP, Logan TK, Martin C, Leukefeld C, Clayton R

AD:   Department of Psychology, University of Kentucky, Lexington 40506, USA. DLYNA1@POP.UKY.EDU

TI:    Project DARE: no effects at 10-year follow-up.

SO:   J Consult Clin Psychol. 1999 Aug. 67(4). P 590-3.

MH: Alcohol Drinking:*PC. Health Education:*. Smoking:*PC. Substance-Related Disorders:*PC. Adolescence. Adult. Child. Curriculum. Follow-Up Studies. Treatment Outcome. Check Tags: Female..  Human..  Male..  Support, U.S. Gov’t, P.H.S..

AB:   The present study examined the impact of Project DARE (Drug Abuse Resistance Education), a widespread drug-prevention program, 10 years after administration. A total of 1,002 individuals who in 6th grade had either received DARE or a standard drug-education curriculum, were reevaluated at age 20. Few differences were found between the 2 groups in terms of actual drug use, drug attitudes, or self-esteem, and in no case did the DARE group have a more successful outcome than the comparison group. Possible reasons why DARE remains so popular, despite the lack of documented efficacy, are offered.

 

 

AU:   Baldwin JA, Trotter RT 2nd, Martinez D, Stevens SJ, John D, Brems C

AD:   Flagstaff Multicultural AIDS Prevention Project, Northern Arizona University, Flagstaff 86011, USA. Julie.Baldwin@nau.edu

TI:    HIV/AIDS risks among Native American drug users: key findings from focus group interviews and implications for intervention strategies.

SO:   AIDS Educ Prev. 1999 Aug. 11(4). P 279-92.

MH: Acquired Immunodeficiency Syndrome:*PC. Health Education:*. HIV Infections:*PC. Indians, North American:*. Substance-Related Disorders:*CO. Adult. Alaska. Alcohol Drinking:PC. Arizona. Colorado. Education. Focus Groups. Risk Factors. Sex Behavior. Check Tags: Comparative Study..  Female..  Human..  Male..  Support, U.S. Gov’t, P.H.S..

AB:   A multisite study funded through the National Institute on DrugAbuse and the Office of Research on Minority Health was conducted in 1996 to determine the HIV/AIDS prevention needs of Native American out-of-treatment drug users. In an effort to recommend directions for HIV/AIDS prevention programming, one component of this study entailed conducting a series of focus groups at each of four sites: Anchorage, Alaska; Denver, Colorado; Flagstaff, Arizona; and Tucson, Arizona. While some site differences were noted, several consistent thematic findings were revealed across all locations. Specifically, focus group members strongly recommended directly involving key members of the Native American community in conducting outreach and intervention activities, involving Native people as the sources of information, and utilizing local and tribally relevant forms of delivering the message. Other consistent themes included getting messages to smaller communities to prevent the potential “annihilation” of tribes, educating youth, and linking alcohol prevention education to HIV/AIDS education. Findings from this study support the idea that future HIV/AIDS prevention programs must take into account subgroup and individual level differences among Native American drug users.

 

 

AU:   D’Aunno T, Vaughn TE, McElroy P

AD:   University of Chicago, USA. tdaunno@midway.uchicago.edu

TI:    An institutional analysis of HIV prevention efforts by the nation’s outpatient drug abuse treatment units.

SO:   J Health Soc Behav. 1999 Jun. 40(2). P 175-92.

MH: HIV Infections:*PC. Substance Abuse Treatment Centers:*. Substance Abuse, Intravenous:*RH. Cross-Sectional Studies. Likelihood Functions. Linear Models. Organizational Policy. United States. Check Tags: Human..  Support, U.S. Gov’t, P.H.S..

AB: Drawing from an institutional-theory perspective on innovations in organizations, this paper examines the use of human immunodeficiency virus (HIV) prevention practices by the nation’s outpatient substance abuse treatment units during a critical period from 1988 to 1995. An institutional perspective argues that organizations adopt new practices not only for technical reasons, but also because external actors actively promote or model the use of particular practices. We examine the extent to which treatment units use several practices to prevent HIV infection among their clients and among drug-users not in treatment. Results from random-effects regression analyses of national survey data show that treatment units significantly increased their use of HIV prevention practices from 1988 to 1995. Further, the results show that treatment units’ use of prevention practices was related to clients’ risk for HIV infection, unit resources available to support these practices, and organizational support for the practices. Implications are discussed for an institutional view of organizational innovation as well as for research on HIV prevention.

 

 

AU:   Obot IS, Hubbard S, Anthony JC

AD:   Department of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.

TI:    Level of education and injecting drug use among African Americans.

SO:   Drug Alcohol Depend. 1999 Jun 1. 55(1-2). P 177-82.

MH: Blacks:*PX. Substance Abuse, Intravenous:*DI/EP. Adolescence. Adult. Cross-Sectional Studies. Educational Status. Hispanic Americans:PX. Student Dropouts:PX. United States:EP. Check Tags: Female..  Human..  Male..  Support, U.S. Gov’t, P.H.S..

AB:   Drawing upon a nationally representative survey sample of African American (AA) drug injectors and non-injectors, this study tests for a suspected causal association between dropping out of school and the occurrence of injecting drug use (IDU), which remains a major cause of human immunodeficiency virus (HIV) transmission in this population. The data are from public use files of the National Household Surveys on Drug Abuse (NHSDA) conducted between 1991 and 1995. From within the NHSDA’s nationally representative sample of adult household residents, a total of 389 AA adults with a history of IDU were matched on neighborhood of residence with 2253 AA adults with no history of IDU. The conditional form of multiple logistic regression was used to estimate the relative risk of having injected a drug for school dropouts relative to a reference category of AA who received the high school diploma but did not go to college. AAs who dropped out of high school were an estimated two times more likely to have injected drugs. With statistical adjustment for age, sex, and Hispanic background, the estimated association was 1.9 (95% confidence interval (C.I.) = 1.3-2.6, P<0.001). Contrary to our advance hypothesis, earning the graduate equivalency certificate (GED) did not seem to affect the magnitude of excess risk for having started IDU (adjusted odds ratio (aOR) = 2.3, 95% C.I. = 1.4-3.8, P<0.001). Hence, school dropout prevention might reduce the risk of IDU per se, in addition to the many other general benefits of educational attainment. The issue of GED-associated reduced risk of IDU remains open for future study.

 

 

AU:   Delva J, Kameoka VA

AD:   School of Social Work, Florida State University, Tallahassee 32306-2570, USA.

TI:    Risk for alcohol and drug abuse among ethnically diverse female recipients of public assistance.

SO:   Ethn Dis. 1999 Spring-Summer. 9(2). P 237-45.

MH: Public Assistance:*. Substance-Related Disorders:*EH. Adult. Alcoholism:EH. Chi-Square Distribution. Cross-Sectional Studies. Hawaii:EP. Logistic Models. Mental Disorders:EH. Pilot Projects. Prevalence. Psychometrics. Questionnaires. Risk Factors. Social Support. Check Tags: Female..  Human..  Support, U.S. Gov’t, P.H.S..

AB:   OBJECTIVE: The present pilot study was conducted to examine the importance of hypothesized psychosocial risk factors in explaining substance abuse among female welfare recipients. DESIGN: The study consisted of a cross-sectional design where participants completed a self-report questionnaire consisting of psychometrically appropriate measures.

PARTICIPANTS: The sample consisted of an ethnically diverse group of 150 adult female recipients of public assistance. The average age of participants was 33 years. Overall, participants were Hawaiian/Part-Hawaiian or Caucasian, unmarried mothers with one or two children, unemployed with an annual family income of less than $5000. RESULTS: Increased alcohol and other drug (AOD) use and related problems were associated significantly with five predictors: mental health problems, aggressiveness, history of AOD problems in family, family cohesion, and lack of social support. CONCLUSIONS: The findings of this study generated a greater understanding of factors associated with increased AOD use and related problems that may be used to assist in the prevention and treatment of substance abuse problems among women living in poverty.

 

 

TI:    Public opinion on psychotropic drugs: an analysis of the factors influencing acceptance or rejection.

AU:  Benkert-O; Graf-Morgenstern-M; Hillert-A; Sandmann-J; Ehmig-SC; Weissbecker-H; Kepplinger-HM; Sobota-K

SO:  J-Nerv-Ment-Dis. 1997 Mar; 185(3): 151-8

AB:  Widespread negative attitudes and irrational beliefs about psychotropic drugs held by the public affect patients’ treatment compliance. This study was an attempt to identify factors influencing people’s acceptance or rejection of psychotropic drugs. An opinion poll was taken by a representative group of 2,176 adults in Germany. In addition to their attitudes toward psychotropic and cardiac drugs and their ratings of perceived risks and benefits, they were also asked about their drug knowledge, their fear of losing self-control, and their fundamental political values. Our results show that even for the treatment of severe mental disease, psychotropic drugs generally are not well accepted compared to cardiac drugs. Psychotropic drugs are believed to cause significantly more severe side effects and provoke more fear of losing control compared with cardiac drugs. Knowledge about psychotropic drugs and experiences with patients suffering from mental disorders are rather limited. Therefore, other sources of information such as negatively tainted reports in the mass media have a significant impact on opinions about psychotropic drugs. Unexpectedly, negative media reports are even more important for the discrimination of distinct subtypes like “acceptors” and “rejecters” of psychotropic drugs than fundamental value orientation. It is recommended that educational and information measures must be enacted to achieve balanced presentation of psychotropic drugs, their effects, and their side effects in the mass media. Improved communication and linguistic elements used in psychotherapeutic settings should be integrated into biological psychiatry to improve understanding of the concepts of mental diseases and their treatment.

 

 

Проекти в ход / Project status reports (Rouse & Giurgiu Initiative

 

 

“Очите на децата - светлината на света

д-р Бисерка Машкова

 

Състоянието на детското здравеопазване е плачевно. Около 1/3 от децата не знаят за очното си страдание. Голяма част от тях имат оплаквания, но досега не са преглеждани. Малка част са тези, които не носят корекцията си.

Целта на проекта е да се диагностицират очните аномалии при децата и да се предпишат съответните корекции.

Зрението се изследва на авторефрактометър, след което се допълва с класическия очен преглед в лекарските офталмологични кабинети на “Интер Оптик” в Русе и Бургас. Прегледите на деца от 7 до 14 годишна възраст са безплатни и се извършват по предварително съгласуван график с ръководствата на училищата.. На децата, които се нуждаят от корекция, се изписват очила. Поръчките се извършват по преценка на родителите. Всяко прегледано дете получава компютърна разпечатка за извършеното изследване с отразени резултати от прегледа, която се прилага в здравния картон и служи като документ за състоянието на зрението му. По нея след време винаги може да се прецени за настъпващите промени.

Социално слабите деца се определят от преподавателите и от социални работници. Рамките за очилата им се отделят в момента. Ако има стъкла в наличност, се изработват за един ден. Ако стъклата са поръчкови, се чака до получаването им - от една до четири седмици.

До момента в Бургас са прегледани около 1300 деца от две училища, както и част от децата в Дома за сираци - 39 /кръглите сираци, които през ваканцията са в дома/. В Русе са прегледани 60 деца от дома за сираци “Р. Гатева”. Изработени са 28 корекционни очила. Предплатени са стъклата за още 11 очила. В Бургас чакат за изработка още 18 поръчки - отделени са 7 рамки - чакат стъкла. В Русе чакат за изработка 19 поръчки - 11 от тях са с рамки; всички чакат стъкла.

     Общо са прегледани около 1400 деца. Предстоят прегледи на децата от Дом за сираци “Св. Димитър Бесарбовски” - Русе. В Бургас трябва да се прегледат оставащите 100 деца от дома.

     Приоритет при следващите прегледи ще имат домовете за сираци. През м. май в Русе ще бъдат прегледани децата от две училища.

     Проектът е разширен: обхваща студентите от ВТУ - Русе. Осъществяват се прегледи на всички нуждаещи се всяка първа и трета събота от месеца. Досега не са изработвани безплатни очила - предлагат се на цени на едро, без заплащане на труда в “Интер Оптик” - Русе.

     За извършената дейност имаме благодарствено писмо от едното от училищата в Бургас. Това намери отражение и в страниците за Бургас на в-к “24 часа”. Имаме готовност за отразяване на дейността в местната преса в Русе.

     Помощ при изработването на очилата оказаха г-жа Мери Петкова и г-жа Светлана Хаджиева. С лични средства са изработени чила на 16 социално слаби деца. Водят се преговори с две фирми за доставка на рамки на преференциални цени.

 

 

Програма за активна арт-терапия с пациенти на Диспансер за психично болни - гр. Русе

г-жа Лилия Иванова

 

     Информирана беше директорката на диспансера за проекта. Тя предложи помещение, което беше оборудвано като художествено ателие. Консултирах се с художник какво би било най-необходимо за обзавеждането му. Осигурени са необходимите материали.

     Пациентите показаха интерест към проекта. Те прекарват голяма част от времето си в ателието, и по-добре сътрудничат при лечението си.

 

 

Образователна програма за стационарните пациенти на Диспансер за психично болни - гр. Русе

г-жа Лилия Иванова

 

     Проектът бе обсъден с директора на диспансера, завеждащите  отделения и председателя на ТЕЛК. С тяхно участие беше редактиран текста на брошурите. Засега са издадени три:

     1. Информация за клиентите на отделението и близките им /за дневния стационар/.

     2. Информация за реда на определяне наличието и степента на трайна нетрудоспособност от психиатрична ТЕЛК.

     3. Информация за близките на психиатрични пациенти, които отказват необходимото им лечение.

 

 

Програма за запознаване на сътрудниците от “Телефон на доверието” със съвременни психотерапевтични и консултативни методи

г-н Рашо Раднев

 

Извършена е подготвителната дейност по проекта:

- изготвена и план-програма за обучение на телефонните сътрудници

- осигурени са /вкл. превод от английски/ обучителни материали за сътрудниците на “Телефон на доверието”;

- петимата новоприети сътрудници са запознати с “Етичната харта”, принципите и общите методи за работа в Службите за телефонна психотерапия;

- подготвен е еднодневен семинар /планиран за 05.04.2000 г./ с всички телефонни сътрудници по проблема за психологична първа помощ и по метода “Фокусирана към решенията кратка терапия”.

    

Осигурени са лектори, зала, материални средства и пособия.

     Оказана беше помощ от ИК на БЧК - обучителни материали, лекции, от РК на БЧК - Русе - помещение за семинарите, видеомагнетофон, монитор, аспектомат и проектор, активист на БЧК - безплатен превод от английски.

     Проектът е с продължителност 6 месеца и реалното обучение едва сега започва. На този етап е събуден интересът на сътрудниците за повишаване на квалификацията им. Очертава се възможност НК на БЧК да организира обучение на част от телефонните сътрудници, включително с лектори от чужбина, с което ще се подпомогне изпълнението на целите на програмата. На семинара в София ще участват 40% от сътрудниците.

 

 

Здравно-възпитателна програма за безнадзорните деца посещаващи приюта на БЧК - Русе

г-н Рашо Раднев

 

     Изготвена е програма за здравното образование и изграждането на здравно-хигиенни навици у безнадзорни деца. Извършено е проучване и е направен анализ на здравословното състояние на преминалите през приюта 309 деца, като информацията е предо-ставена на ХЕИ - Русе. Формиран е екип за осъществяване на проекта. Съвместно с отдел “Профилактика и промоция на здравето” при ХЕИ - Русе са определени обемът и начините за здравно образование и възпитание на безнадзорните деца, уточнено е сътрудничеството по време на изпълнение на проекта. На 22.03.2000 г. е проведен еднодневен семинар за обучение на персонала на приюта и доброволци /19 души/ - “Санитарно-хигиенни грижи и здравно образование на безнадзорните деца в Русе”.

     За един месец са обхванати в системата на здравното обучение и са получили медицински и хигиенни грижи 22 деца. Експериментирани са форми и методи на здравно-възпитателна работа от екипа съобразно възрастта, образованието и времето за престой на децата в приюта.

     Популяризиран е проектът и спонсорите - фондация “Отворено общество” и медицинска фондация “Драйфус” в пресата - в-к “Утро” от 21.03. и 23.03.2000 г. Осъществени са контакти с Детска педагогическа стая и е осигурено съдействие за насочване на безнадзорни деца към приюта.

     ХЕИ - Русе предостави печатни и нагледни материали, видеофилми, РК на БЧК - зала за семинара и транспорт.

     Формиран е и е обучен екип от щатни служители и доброволци за работа с безнадзорните деца във връзка със здравното им образование. В обучителната програма са обхванати 22 безнадзорни деца.

    

 

 

Програма за обучение на общи хирурзи в техниките на ендоскопската хирургия

д-р Силви Йорданов

 

     Основната цел на програмата е да се създаде и поддържа Уеб сайт с оперативно ръководство и атлас за различните ендоскопски оперативни техники, който да подпомогне обучението на ендоскопски хирурзи. До момента разполагаме с видеоматериал от над 100 собствени ендоскопски операции, осъществени в хирургична клиника “Медикус” - гр. Русе. Създаден е Уеб сайт, който е с интернет адрес: http://www.endosurgery.dir.bg/ и е включен във всички български портални сайтове за търсене в сектор “Здравеопазване”. Изготвени са и са публикувани заглавната страница и общия дял от оперативното ръководство. В момента се пишат страниците с различните оперативни техники.

     Осигурени са компютърни компоненти за обработка на видео-материалите и устройство за тяхното архивиране на компактни дискове, което улеснява използването и публикуването им в Интернет.

     Оказана помощ от ХК “Медикус” с предоставената операционна база, архив, локална компютърна мрежа и Интернет достъп.

     Изработено е част от съдържанието на Уеб сайта и е публикувано в HTML формат. Работи се върху специализираните секции.

     Считаме, че поради силно ограничените възможности за обучение в ендоскопската хирургия и липсата на оперативни ръководства на български език, материалите, публикувани в Уеб сайта ще са от полза за начинаещи ендоскопски хирурзи от цялата страна.

 

 

Програма за обучение на болни с хронична бъбречна недостатъчност за необходимия им диетичен режим и начин на живот

д-р Лъчезар Арабаджиев

 

     Проблемът, към който е насочен проектът, е неинформираността на пациентите с хронична бъбречна недостатъчност /ХБН/ от гр. Русе по отношение на диетичния режим и начин на живот, оптимални за тяхното здравно състояние.

     Спазването на този режим може да доведе до отлагането на хемодиализното лечение с 10 години. Цената на една хемодиализна процедура е около 150-200 щ.д.

     Извършените до момента дейности включват следното:

     Осъществи се отпечатването на брошура с информация за необходимите хвани, белтъчното им съдържание и принципите на организация на диетичното хранене. Разлепиха се съобщения за организираните срещи. Потърсени бяха и лични контакти с някои болни за популяризиране на идеята.

     Проведоха се два срещи с целеви групи от по 20 пациенти. Там им беше разяснено как на практика се изработва диетата, използвайки информацията от предоставената им брошура. Отговорено беше и на зададени въпроси. Датите на срещите бяха съответно 21.03. 4 01.04. 2000 г. Интересът беше голям и сега продължават запитвания за нови дати за семинари.

     Оказана беше помощ от диетолог за изработване на брошурата. Безплатен контрол на нивото на урея за тези 40 болни.

     Поради технологичното време от 1 м. след обучението за осъществяване на лабораторен контрол, такъв не е осъществен, но е обещан /вж. горе/.

     Считам, че проектът има добро начало. Основният проблем, който очаквам, е  с безплатния лабораторен контрол след 1.07.2000 г., когато влиза в сила новата здравно-осигурителна система. Тогава ще е необходимо заплащане на тези изследвания.

 

 

Необходимост от пълноценно обучение на болните от бронхиална астма с цел подобряване качеството на живот и контрол на симптомите на симптомите на болестта

д-р Йорданка Дачева

 

     1. Осигурено помещение.

     2. Частично оборудване на кабинета за индивидуална и колективна работа с пациентите.

     3. Осигурена зала с аудио-визуално оборудване за сбирки по предварителен график /подпомогнато от УМСА - Русе/.

     4. Набрани групи пациенти, селекционирани по тежест на оплакванията и стартиране на работата с тях.

     5. Извършено закупуване на необходимите технически пособия - от Glaxo - Welcome.

     6. Осигурена компютърна конфигурация за безвъзмездно ползване - от Glaxo - Welcome.

     7. Закупени канцеларски материали.

     8. Закупена специализирана тематична литература по проекта.

     9. Осигурена общообразователна литература по темата за пациентите /брошури, листовки/.

     10. В подготовка - изготвяне на анкетни карти за пациентите с цел проследяване на тежестта на пристъпите и ефект от индивидуалната работа с тях.

     Оказана помощ от Glaxo - Welcome, УМСА - Русе, сдружение “Бял дроб” - Русе.

     Междинна оценка на резултатите до момента показва, че дейностите са вместени в указаните в проекта срокове. Дейността ни среща добър отзвук сред пациентите.

     Поради спецификата и мащабността на проекта периодът е недостатъчен за окончателна оценка на ефективността му.

 

 

Програма за оценка на нуждите от психиатрична помощ за децата, обхванати от ОбКБИПМН - Русе

д-р Людмил Георгиев

 

     Беше уведомено ръководството на ОбКБИПМН - Русе за проекта. Беше разработена стратегия за изпълнението му. За по-пълно удовлетворяване на потребностите на децата и техните семейства проектът беше разгледан като интегрална част от пакет програми, за които беше потърсено финансиране.

     Проектът беше консултиран с доц. Надя Полнарева, ръководител на Консултативна клиника по детска психиатрия към Катедра по психиатрия на Медицински университет - София. Беше разработено полуструктурирано интервю за децата и такова за родителите.

     Проведоха се пилотни интервюта с цел уточняване на полуструктурираното интервю.

     Въпреки сериозните финансови затруднения времевият график на проекта не бе нарушен.

 

 

Необходимостта от профилактика, ранна диагностика и лечение на остеопорозата при рискови групи пациентки в работоспособна възраст

д-р Надежда Капанджиева

 

     В групата са включени пациентки, преценени като рискови от диспансерите на ревматологичен кабинет и гинекологичен кабинет /ранно хистеректомирани или трайно кортизонирани/.

     Проведени са лекционни курсове и раздадени листовки на пациентките. Курсовете се провеждат ежеседмично с групи по 15 пациентки. Лекции бяха излъчени и по местната телевизия с открита телефонна връзка.

     Проведени са безплатни гинекологични и мамографски прегледи на пациентки, които са за хормонално-заместителна терапия.

Оказана е финансова помощ на социално слаби пациентки, които се нуждаят, но не могат да заплатят изследването. Оказана помощ от местни предприятия и еднолични фирми за закупуване на принтер към остеометъра, заплащане на част от остеометриите и част от лечението на някои пациентки, работещи в предприятията.

 

 

Одобряване на ранната диагностика на карцином на простатата

д-р Мирела Вълкова

 

     Осигурен кит за PSA. Изготвени са брошури за пациентите, осведомяващи ги за целта на изследването. С проекта са запознати уролози и интернисти. Започнало е събирането на серуми за изследване.

 

 

Практическо обучение на общопрактикуващи лекари в Русенския регион”

д-р Боряна Тодорова

 

Уточнен е броят на участниците в програмата за обучение. До момента съгласие за участие са заявили 10 общопрактикуващи лекари, които в момента работят в I Медицински център.

Постигната е договореност с управителя на I Медицински център за използване на базата необходима за провеждане на практическото обучение. Медицински център се ангажира за предостави необхо-димата материална база и да оказва съдействие при обучението.

Закупени са част от необходимите консумативи и инструментариум за обучението.

Мероприятията по проекта се провеждат съгласно предварителния график.

 

 

“777 без дрога”

д-р Е. Светославова

 

Изготви се лекция на тема “Наркомании” с времетраене тридесет минути и с цел по един научен, но и достъпен и отчасти забавен начин да се завладее аудиторията. Използуваха се монографии, лекции, съобщения по темата, разговори с ученици, учители, родители, консултации с психотерапевт. Лекцията се размножи и се предостави на всички желаещи класни ръководители и ученици и бе изнесена двукратно в аулата на АРТ.Милев” при много голям интерес. На нея присъствуваха общо 333 ученици, както и учители и представители на местните медии, където събитието беше отразено. На всички присъстващи се раздаде листовка и брошура.

Обявиха се три конкурса по темата:

• Конкурс есе с три награди

• Конкурс рисунка с три награди

• Конкурс дебат с три награди

Излъчиха се седемнадесет ученици, желаещи да работят по проблема. С тях се проведоха две сбирки. При реализирането на проекта активно участие взема и м. ф-р М.Трайкова от училищната здравна служба.

Работеше се индивидуално с 11 ученици, склонни към употреба на наркотични вещества. След активно проследяване същите на празненства и “купони” не са употребявали наркотични вещества. Срещите с тях продължават.

 

 

Програма за контролиране на кръвно-захарното ниво у деца, болни от захарен диабет

Д-р Лидия Цонева

 

Проектът стартира през месец февруари 2000 год. Неговата цел е чрез изследване показателя на гликирания хемоглобин да се установи кои деца диабетици се нуждаят от по-интензивен контрол над инсулиновото лечение и режима на хранене. Това от своя страна ще доведе до по-добър метаболитен контрол и по-малък процент на съдови усложнения.

През месец февруари се проведе изследване на гликирания хемоглобин у 10 деца - диабетици. Според получения резултат се подбраха 5 деца - диабетици, чийто резултат сочеше, че в последните четири месеца не са били добре компенсирани. Те ще бъдат подложени на по-усилен контрол чрез редовно следене на моментното кръвно-захарно ниво и хранителния режим. През март 2000 год. проведохме беседа относно правилното формиране на хранителния режим при диабетно болното дете и беседа относно влиянието на двигателния режим върху нивото на кръвната гликоза.

Провеждаха се ежеседмично кръвно-захарни и урино-захарни профили - през 3 часа, а също изследване на кръвната гликоза при всеки будещ подозрение симптом.

 

 

Програма за ранна рехабилитация на деца, прекарали перинатална асфиксия

д-р Даниела Бурмова

 

     Формиран е екип от неонатолог и медицинска сестра. Подготвен е формуляр с критерии за оценка, на базата на който се формира наблюдаваната група. Подбрана е и контролна група с пациенти от 1999 г. До м. април 2000 г. са обработени 4 деца и са включени в наблюдаваната група. Приложена е ранна кинезитерапия, майките са информирани за проблема. От тях една пожела да бъде обучена и да продължи в домашни условия приложението на кинезитерапията. Поради ниската ангажираност от страна на останалите майки ще се проведе една обща среща, на която по достъпен начин те отново ще бъдат запознати с възможностите на програмата, в която им предлагаме да се включат.

 

 

Програма за ранна диагностика и своевременно лечение на ретинопатията у недоносени деца от гр. Русе

д-р Нина Гамакова

 

     Програмата се осъществява на база Неонатологично отделение, ДМД и амбулаторно проследяване на обхванатия за изследване контингент - недоносени деца с тегло под 1500 гр. и родени преди 30 гестационна седмица. До настоящия момент се осъществи следното:

     1. Беше сформиран екип от неонатолог и офталмолог.

     2. Регистриран беше и изследван контингентът, роден от 1 януари до 31 юни 1999 г. като база за сравняване. За този период 2 от обхванатите общо 14 деца са с доказана ретролентарна фиброплазия.

     3. Провеждат се събеседвания с родителите с цел изясняване рисковите усложнения, резултат от тежката степен недоносеност, както и от инвазивното интензивно, но животоспасяващо тера-певтично поведение.

     4. Всяко дете от изследваната група, родено от 1.07.1999 г. до настоящия момент, е картотекирано с ежемесечно изследван неврологичен статус, трансфонтанелно ехографски изследване, офталмологичен преглед.

     Обработените до края на 1999 г. пациенти нямат очна патология. В ход е обработката на пациентите, родени след 1.01.2000 г.

 

 

Просветно-профилактична програма за намаляване риска от мозъчно-съдова болест

д-р Павел Бойчев

 

     По направения проект към дата 31.03.2000 г. са извършени следните мероприятия:

     1. Започна изграждането на база от данни, като към настоящия момент са осъществени контакти с 168 рискови пациенти.

     2. Така набраните пациенти биват разпределяни в 4 групи, съответно:

     а) хипертоници

     б) сърдечно-болни с проводни нарушения

     в) болни с подходни нарушения на мозъчното кръвоснабдяване

     г) такива с наднормено тегло или дислипидемии.

     На всеки болен се предоставя листовка с препоръки, касаещи хранителен двигателен режим и насрочени дати, на които ще се провеждат срещите с целевите групи.

     Към настоящия момент работата по проекта се осъществява в района на Районна болница - Русе. Предвижда се на втория етап от проекта да се извършват срещите с целеви групи в подходящо за целта помещение.

    

 

Програма за обучение на родители за обгрижване на деца с остри заболявания

д-р Татяна Матева - Иванова

 

     - Среща с ръководството на СОУЕЕ “Св. К.К. Философ” - гр. Русе със задача уведомяване за същността и целта на проекта и получаване на съгласието му за осъществяването на проекта.

     - Осъществи се среща с ръководителя на “Детски сектор” на I-ва поликлиника.

     - Сформира се екип от училищен фелдшер, училищна сестра и лекар, разпределиха се задачите.

     Подготвиха се и се отпечатаха входящите и изходящите анкети и образователните материали. Започна същинската работа по проекта - анкетиране на родителите при преглед на детето по повод остро вирусно заболяване, разпространение на материалите /брошури за грижи за детето, болно от инфекциозна диария, остра респираторна вирусна инфекция/, провеждане на провеждане на изходящата анкета при контролния преглед на детето в лекарския кабинет.

     В момента продължава същинската работа по проекта - анкетиране, разпространение на образователните материали.

     Анализът на проведените до момента анкети показа желанието на родителите да получат повече знания относно обгрижването на детето.

     Стартирането на проекта закъсня особено в етапите, свързани с изработването на анкетите и образователните материали и отпе-чатването им поради закъснение във финансирането на проекта.

 

 

Алтернативна професионална подкрепа за злоупотребяващи с дрога ученици и семействата им

д-р Бойко Иванов

 

     Осъществяването на проекта започна в предварително начертания срок. Сформираха се работните екипи от медицинските лица  в двете средни училища - “СОУЕЕ “Св. К.К. Философ” и СУИ “Проф. Веселин Стоянов”. Бяха получени съгласието и подкрепата на ръководните екипи в двете училища.

     Същинската работа по проекта - изработването на анкети и информационни материали и извършването на анкета на входа на проекта започна след получаването на целевите средства по осъществяването на проекта през м. март.

     Уточнен е график за консултиране в офиса на “Общество Х”.

     Следва разпространение на информационните дипляни.    Оказана бе помощ от Еко-клуб от ученици от СОУЕЕ “Св. К.К. Философ”и “Общество Х” - използване на офис за целите на проекта.

     Анализът на анкетите показа предварително очакваната нагласа - незначителна готовност за търсене на специалист, въпреки осъзнаването на проблема. По-висока вероятност за консултиране има при безплатен прием и в условията на частен кабинет.

         

 

Здравно-образователна програма за населението по правните аспекти на здравно-осигурителната система

Румяна Николова

 

     Увеличен бе броят на публикациите по проблема във в-к “Оферти” от месец януари 2000. Има отклик от страна на читателите. Публикуваха се интервюта със специалисти по проблемите на здравната реформа.

 

 

Социално-рехабилитационна и терапевтична програма за деца с муковисцедоза

г-жа Петрана Колева

 

     За периода март-април 2000 г. бяха осигурени лекарствени препарати и диетични храни съобразно нуждите на децата, боледуващи от муковисцедоза. В качеството си на ръководител на проекта посетих техните домове, тъй като при стартирането на програмата децата бяха с влошено здравословно състояние. Бяха раздадени лекарства и диетични храни. Разпределението се извърши според нуждите на децата.

     Д-р Пейчева, завеждаща градски гастроентерологичен кабинет, обясни на родителите как да използват раздадените лекарствени средства и диетични храни. Разяснена беше необходимостта от диетично хранене.

     На 28  и на 30 март д-р Панайотов проведе разговори с родителите на болните от муковисцедоза деца. Бяха обсъдени проблеми от психо-социален характер. Внимание беше отделено на емоционалното състояние на болните с оглед невъзможността да осъществяват пълноценен контакт със своята естествена среда в детската градина и училището поради честото боледуване. Проблемът за социалното реализиране на децата е труден и се обмисля индивидуално за всяко дете съобразно възрастовите особености, индивидуални наклонности и предпочитания.

     Оказана беше помощ от д-р Пламен Панайотов, д-р Мария Пейчева, Рашо Раднев - психолог.

     Реализира се програма, спомагаща за по-доброто здравословно състояние на болните. Осмисли се ролята на диетичното хранене, непрекъснатата терапия с поддържащи медикаменти.

    

 

Организиране на група за самопомощ на болни от остеопороза

г-жа Людия Йочева

 

     На 28 март бе проведена първата сбирка и бе обявена програмата за действията на групата: срещи със специалисти (ендокринолог, кинезитерапевт, психотерапевт, диетолог). На 28 март е проведена и анкета сред участниците на тема: “Какво очаквам от групата и какво аз мога да помогна на себе си и другите, какви умения притежавам”.

     От отговорите на попълнилите анкетата личи, че те желаят да опознаят изцяло това заболяване, фазите на развитие и тяхното предотвратяване чрез здравословен начин на живот, да знаят какви са оптималното за тях физическо натоварване и хранителна диета.

     Болните очакват и разбиране от страна на координатора и помощ при възникване на проблем - здравен, психологичен или профе-сионален.

     Организирана е среща с ендокринолог - Ани Киселова с беседа за заболяванията, от които се получава остеопорозата и начинът за нейното преодоляване в различните й стадии, както и среща с кинезитерапевт с оглед максималното физическо натоварване и релаксация - д-р Димитров. Проведена е беседа и с психотерапевт.

Групата се събира 2 месечно – за разходки сред природата, за сутрешна  гимнастика в събота или неделя.

     Групата обсъди покана от фондация “Българка” за участие в изложба - базар в НДК - София. Всички са готови да участват с предмет, изработен от тях. На всички събирания групата получава почерпка и ползване на Остеовитал, Cа, Mg, Zn.

     Засега участниците не ползват хормонално-заместителна терапия.

     Следим нивото на Ca в кръвта. Спазва се режим на хранене, физическо натоварване, съобразено със стадия на развитие на остеопорозата.

 

 

“ЗА ПОВЕЧЕ ГОДИНИ ЖИВОТ И ПОВЕЧЕ ЖИВОТ ПРЕЗ ГОДИНИТЕ”: ИНТЕРВЮИРАНЕ НА ХРОНИЧНО СОМАТИЧНО БОЛНИ ЗА ВЪЗМОЖНОСТИТЕ ИМ

д-р Пламен Панайотов

 

На начална работна среща с колеги от ОРБ, ДПБ и ДББ те бяха запознати с проекта и метода на фокусираната към решенията терапия и консултиране. Уточнихме начините за взаимодействие и отговорностите при провеждане на дейностите по проекта.

Консултирахме проекта със специалисти в областта на психо-логичното консултиране от Обществото на краткосрочните терапевти в България, а чрез Интернет – и с Европейската Асоциация за кратка терапия, Северногерманския институт за кратка терапия в Бремен и други институции, прилагащи подхода в соматичната медицина.. Набавени са необходимата литература и материали и е изготвена брошура за запознаване на потенциалните участници в програмата с предлаганите услуги.

Проведоха се първите интервюта с хронично соматично болни

пациенти и семействата им.

Проведе се първият семинар със специалисти от други професии за запознаването им с метода.

Проведе се първият семинар със сътрудниците на службата за телефонно консултиране на БЧК – Русе, на който те бяха запознати с метода.

Оказана ни е помощ от:

- Ръководството на Диспансер по психични болести - Русе и фирмата Janssen - Cilag осигуриха мястото за реализиране на сесиите и срещите.

Колегите д-р Дачев, д-р Арабаджиев, д-р Вълкова, д-р Лисичков и д-р Пенчева запознават показаните си соматични пациенти с предложението и ги насочват за консултиране.

Резултатите ще  бъдат съобщени и дискутирани при приключването на проекта.

 

 

ROUSE-GIURGIU INITIATIVE OF THE PROBLEM SOLVING FOR BETTER HEALTH PROGRAM, NOVEMBER 1999 PROJECT STATUS AS OF APRIL 2000 (SUMMARIES)

 

Timely diagnosis and correction of ophthalmologic anomalies in school children

(Dr. Bisserka Mashkova)

 

The aims of the project are to carry out eye examinations for children, and upon finding out any anomalies – to prescribe glasses. 

So far, 1400 aged 7-14 children from 7 schools in Rouse have been examined, 60 of whom from an orphanage.

Also, 1300 children from Bourgas were examined (INTER – OPTIC, the firm for which the coordinator works has an office there as well). Of the children examined in Bourgas, 39 are from an orphanage.

All the children with problems were registered for follow-up.

Efforts are made to reduce to a minimum the price of glasses for the orphans (sponsors, volunteer work of doctors and technicians)

Plans for the near future:

to examine the children from two other orphanages – 1 in Rouse and 1 in Bourgas; 

to examine the children (aged 7-14) from two other schools in Rouse;

to examine students from  the Technical University in Rouse  twice a month;

to find opportunities for providing glasses at a discount for all children who need a pair.

Collaboration with: school authorities, orphanages, optic firms, the media.   

 

 

An educational program for psychiatric patients on their rights and obligations to improve compliance with treatment

(Mrs. Lilia Ivanova )

 

The project was discussed with the director, heads of wards and the chairman of the expert medical committee. They helped with editing the brochures, which are meant to provide more information for the patients in regard to their rights and obligations, and on the institutions outside the hospital that are involved to help them. Three brochures were prepared and distributed on the following topics:

information for day-patients and their relatives;

information on what steps are taken when a psychiatric patient is to be registered with working disability

information for the relatives of psychiatric patients who do not comply with treatment.

 

 

Teaching modern psychotherapeutic and consulting techniques to Green Phone Line Staff in Rouse

(Mr. Rasho Radnev)

 

A program was designed for the training of the staff. Teaching materials were provided. The newly appointed 5 staff members were introduced to the ethical principles they need to abide, and the methods applied in phone psychotherapy. A one-day workshop was organized with all members of the staff on problems of psychological first aid and the method of short-term ability-focused therapy. Trainers, facilities teaching aids were provided.

Collaboration with the Red Cross in Rouse is of utmost importance.

The staff has shown interest in the training program, and considers it useful in developing their skills. At a later stage, the Bulgarian Red Cross National Committee will organize a workshop with lecturers from other countries, which will be attended by 40% of the staff.

 

 

A training program for 10 general surgeons in the techniques of endoscopic surgery to reduce costs of treatment for surgical diseases

 ( Dr. Silvi Yordanov)

 

The aim is to create and maintain a WEB -site with a instructions on various  endoscopic surgical techniques, and help with the training process of endoscopic surgeons. So far, over 100 endoscopic operations performed at the “Medicus” private surgery clinic in Rouse have been videotaped and put on the INTERNET. The site is: www.endosurgery.dir.bg. It is to be found under “Health” in www.dir.bg.

The “Medicus” private surgical clinic provided operationg rooms, files, local computer facilities and access to internet. Part of the web-site is ready, and the materials are accessible in HTML format. The preparation of the specialized pages is in process.

 

 

A program for active art-therapy of patients of the Dispensary for Mental Diseases in Rouse

(Mrs. Lilia Ivanova)

 

The project was presented to the director of the dispensary, who provided a room, which was furnished as an art studio. Materials were purchased – watercolors, oil paints, pencils, canvas, ink, paper, rubber, etc.

Patients showed great interest in the project. Now, they spend a lot of time in the studio, and are more compliant with the therapy  prescribed.

 

 

Education for patients with chronic kidney failure on proper diet and healthy life-styles

 (Dr. Lachezar Arabadjiev)

 

Proper dietary regimen could postpone hemodialysis in patients with chronic kidney failure with up to ten years. That is why the efforts will be oriented to train patients. The target group will possibly include 150 selected patients. The effect will be evaluated by measuring the serum level of urea ( reduction desirable being under 20mmol/l).

So far, a brochure has been prepared after consultations with a dietitian, informing patients about the principles and methods of dietary treatment. Two workshops have been conducted with two groups of 20 patients each.  The first control test to evaluate the effect of diet on the 40 patients is to be carried after one month.

 

 

Education for asthma patients in Rouse

(Dr. Yordanka Dacheva)

 

A room for individual and group work with the patients selected was provided and furnished. The patients were distributed in groups according to the degree of severity of the their condition. Brochures and leaflets were prepared for the patients. Other materials - questionnaires,  charts are being prepared to enable continuous assessment of the effect on  patients’ condition. The activities of the project team were financially and otherwise supported by: GLAXO-WELLCOME, YMCA - Rouse and Rouse Lung Association.

The project was well received and aroused the interest and compliance of the patients.

 

 

Assessment of the needs for psychiatric help of delinquents registered at the preventive center in Rouse

( Dr. Lyudmil Borisov)

 

Together with the staff of the municipal center in Rouse for prevention of delinquent adolescent behavior, a strategy was built to implement the project within an integrated packet of programs.  The aim is to meet the needs of both delinquent adolescents and their families of psychiatric consultations. Semi-structured interview patterns were designed for children and parents, and pilot interviews were carried out.

Collaboration with  Assoc. Prof. Nadya Polnareva, head of the pediatric section of Department of Psychiatry, Medical University of Sofia clinic was of great help.

 

 

Teaching hygienic skills to 50 street children aged 7-14 visiting and living at the Red Cross placement center in Rouse

 (Mr. Rasho Radnev)

 

A program for health education and teaching hygienic skills in street children was made with the assistance of the health promotion department. . The local Hygiene and Epidemiology Station provided analysis of the health status of 309 children who visited the center. A team was built, and activities in collaboration with the station planned.  The station also provided the printed and visual teaching aids, and the Red Cross helped with organizing a one-day workshop on health education and building hygienic skills in street children was organized for the staff of the center and 19 volunteers.

For one month (March), 22 children were trained and educated, the approach depending on their age, education level and the length of stay at the center.

The local media presented the project to the public.

 

 

Prevention, early diagnosis and treatment of osteoporosis in risk patients of active age

 ( Dr. Nadezhda Kapandjieva)

 

Patients were selected from the files of the consulting rooms of rheumocardiology and gynecology (early hystectomized or on a long-term corticosteroid therapy).

A course of lectures was carried out (once a month with 15 women), and leaflets distributed. A series of TV talks on the problem was broadcasted on the local TV center.

Low-income patients were provided with medication free of charge. Those on hormone-replacement therapy underwent a gynecological and mammography.

Purchase of a printer for the osteodensitometer, osteometric examinations and part of the medicines for some of the patients were provided for by their employers.

 

 

A screening program for improving rates of early diagnosis of prostate cancer 

( Dr. Mirela Valkova)

 

Materials for testing prostate-specific antigen levels were provided.

Brochures were prepared and distributed, and the target group of patients is being selected.

 

 

Organizing a self-support group for patients with osteoporosis

(Mrs. Liudia Yocheva)

 

     At the first meeting in March the program of the group was agreed upon, and it also included regular meetings with specialists: endocrinologist, kinesitherapist, psychotherapeutist, dietitian. Participants also filled in questionnaires as to what their expectations are, what they could do for themselves and the otyher members of the group, and what their capabiliities are.

     The analyses showed that they want to know about the condition, life-style, diet and exercise. They rely upon understanding and support from the project coordiantor when they need to solve a health, psychological or professional problem.

     Meetings were organised with an endocrinologist (Dr. A. Kisselova), a kinesitherapist (Dr. Dimitrov), and a psychotherapist (Dr. P. Panayotov).

     The group comes together every two weeks for walks in the open, and for exercise on the weekend.

     Everybody from the group was invited to participate in a charity sale organised by another foundation, where members of the group will present with items they make.

     Participants do not take hormone repalcement therapy for the time being.  Their blood calcium level is checked, as well as how they observe the diet and exercise regimen prescribed according to the satge of the disease.

 

 

Organizing practical training for General Practitioners in Rouse 

(Dr. Boryana Todorova)

 

So far, ten general practitioners have been included in the training group.  The facilities of Medical Center One will be used for the practical training. Part of the materials needed have been provided.

 

 

We – the 777 drug-free: an educational program on the harmful effect of drugs for the students of the English Language School in Rouse

(Dr. Elisaveta Svetoslavova)

 

A 30-minute lecture was prepared on the harmful effect of drugs, after consulting with psychotherapists, teachers, parents, monographs, and lectures. The material compiled was photocopied and distributed among class teachers and students. Two meetings were organized at the school, attended by 340 students altogether, and the local media reported them. All present were given a brochure and a leaflet. Competitions were organized for essays, drawings and a debate on the topic. Seventeen students were selected to work on the topic (peer education), and two meetings have been carried out so far. Apart from that, individual work was carried out with eleven students inclined to use drugs. Initial results show positive effect from the sessions.

 

 

A follow-up program for children with diabetes mellitus to postpone complications

 ( Dr. Lidia Tzoneva)

 

The project started in February 2000, aiming at measuring glycosylated hemoglobin of diabetic children, thus detecting those in need of more intensive control of insulin treatment and dietary regimen. This is expected to better metabolic control and less vascular complications.

The first group included 10 children, whose results showed low compensation. They were registered for special observation – more regular checks of blood glucose and  proper diet.

 

 

Early diagnosis of complications due to perinatal asphyxia in newborns and timely referral for cerebral palsy rehabilitation

(Dr. Daniela Bourmova)

 

A team was formed of a neonatologist and a nurse. The  criteria for selection of the patients were discussed and agreed upon. The control group includes cases from 1999. Between January and April 2000, 4 babies were included in the target group, and early kinesitherapy was applied. Mothers were informed about the problem. One of them was interested in being trained, and to continue rehabilitation in the home. Because of the lack of interest on behalf the rest of the mothers, another meeting with them has been planned, and they will again be presented the possibilities offered by the program for early rehabilitation.

 

 

Early diagnosis and timely treatment of retinopathy in low birth weight infants

(Dr. Nina Gamakova)

    

     The team working on the projects includes a neonatologist and an ophthalmologist. A control group was selected of children with birth weight lower than 1,500g, or delivered  before the 30th gestation week, and born between January 1st and June 30th, 1999. Of the 14 children from the control group, 2 of 14 children were diagnosed with retrolental fibroplasia.

     The project was started at the neonatology unit of the maternity hospital, a placement center and out-patient consulting rooms, and the target group includes children selected using the same criteria as the ones used fir the control group.

     Parents of all risk children are informed about the risks of complications due to both severe prematurity and intensive life-saving therapy.

     Every infant born between July 1st, 1999 and April 2000 has been registered for follow-up, which includes monthly neurological assessment, transphontanelle ultrasonography and ophthalmological examination.

     No retinopathy was found in children born during the second half of 1999. The infants born after January 1st 2000 are currently assessed.

 

 

Health education to decrease cerebrovascular risk

(Dr. Pavel Boichev)

 

     Contact has been established with 168 risk patients up to March 31, 2000. These were divided into 4 target groups: 1) hypertensive patients, 2)cardiac patients with conductive  cardiac failure, 3)patients with impaired blood supply of the brain, 4)patients with obesity or lipidemia.

     Each patient  received a leaflet with recommendations on appropriate diet and exercise, and information about the dates of meetings with the target groups.

     The project  activities are now carried out at the regional hospital in Rouse. Later,  the meetings with the target groups will be held  outside the hospital.

 

 

Educating parents how to take proper care of children with acute diseases

 (Dr. Tatyana Mateva - Ivanova)

    

     The project was presented to the school authorities of the school for European languages in Rouse  - St. Constantine - Cyril the Philosopher, and the pediatric unit of the first policlinic. The team formed includes a pediatrician, a nurse and an assistant.

     Questionnaires were prepared to assess the level of knowledge of parents as to how they are expected to take proper care of the child with acute disease ( infectious diarrhoea, acute respiratory virus infection). All parents were provided with brochures instructing them how to take care of the sick child if diagnosed with an acute illness at the consulting room. Then they were asked to fill in a second questionnaire when they brought the child for a follow-up examination after recovery.

     Analyses of results so far show that parents are willing to be given more information regarding care of the sick child.

 

 

A survey to study the relationship between air pollution and chronic lung diseases and morbidity in children aged 7-15 in Rouse

(Dr. Margarita Nickolova)

 

     Public transport in Rouse is intensive, and the air is polluted, mainly with dust and Nox. An ecological survey was carried out to assess the type and level of pollution at two points in Rouse based on data collected for the period 1997-1999. 

     A questionnaire was prepared for 800 children to assess lung disease incidence and severity. Meetings with teachers were organized at Toma Kardjiev school.

     The project was supported by the local Hygiene and Epidemiology station: they provided the data for ecological assessment and computer equipment.

     The project is expected to be completed by the end of the year 2000. If  the connection between levels of air pollution due to public and lung disease incidence is proved,  a change in the routes of  buses will be recommended. 

 

 

Alternative psychological assistance for adolescent drug abusers and their families

(Dr. Boiko Ivanov)

    

     The project started in two schools in Rouse - the school for European Languages and the musical school. School authorities in both schools support the project.

     Questionnaires and health education materials (brochures, leaflets) were prepared. Those in need were invited for consultations at the “X”  society  office.

     Student members of the ecology club at the language school  helped with the activities, and “X” society provided the venue for consultations for students who sought help.

     Initial analysis of questionnaires showed that students are not ready to seek help from a specialist, although they realize the severity of the problem.  Inclination to seek help was associated with a doctor in a private consulting room and free of charge.

 

 

A health-education program for the population on the legal issues of the heath insurance system

(Ms. Roumyana Nickolova)

 

     The number of articles published in a local newspaper (OFERTI) has been increased since January 2000. There is response from readers of the paper. Based on the feedback from them, a number of interviews were published with experts on health issues and those of the changes in the health system in the country.

 

 

A psychosocial program to improve the quality of life of children with mucoviscidosis

(Mrs. Petrana Koleva)

 

Medicines and diet food were provided for the children. They were all visited in their homes.

The parents of the children had a meeting with Dr. Peicheva, a gastroenterologist, who instructed them on how to use the foods and the medicines, and on proper diet.

At a meeting of the parents with a psychotherapist (Dr. Panayotov) and a psychologist (Mr. Radnev), psycho-social problems of the children were discussed. Special attention was paid to their emotional status due to lack of contact with children of their age at the kindergarten or school due to their poor health. The problems of socal integration of the children are difficult to solve, and attempts are made to find a solution for each child in view of his or her age, interests and talents.

The program contributes to improve the health and emotional status of these children. It is also useful for the parents:– now they know more about diet and the continuous therapy.

 

 

For more years of life and more life in the years: a program for ability-focused psychosocial counseling for patients with chronic somatic diseases

(Dr. Plamen Panayotov)

    

     Colleagues from the regional hospital, the lung disease clinic and the mental disease clinic were informed about the project. The method of ability-focused focused psychosocial counseling for patients with chronic somatic diseases was presented at the meeting, and potential benefits for patients were discussed. Coordination in activities was organized These activities were planned after a careful study of the experience of other institutions applying the method in somatic medicine: the Bulgarian Society of Short Term Psychotherapy, the European Association of Short-Term Psychotherapy, the Bremen Association, etc. On the basis of literature, brochures were prepared for the patients.

     A couple of interviews were realised with patients with chronic somatic diseases, and with their families. A workshop was organised where the method of the ability-focused interview was preseted to health and social workers.

     The local representatives of Janssen – Cilag helped in organizing the meetings and interviews. Colleagues from different specialties – Dr. Dachev, Dr., Arabadjiev, Dr. Lisichkov and Dr. Pencheva refer their somatic patients for consultations.