Digest 12

Спонсорирано от: Dreyfus Health Foundation

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Съдържание

НОВИНИ / NEWS

MEDLINE INFORMATION

- Nosocomial Infections / Вътреболнични инфекции

- Palliative Care / Палиативни грижи

Suicide: Patterns and Prevention / Самоубийства и превенция ПЛЕВЕНСКА ИНИЦИАТИВА: ПРОЕКТИ PLEVEN INITIATIVE PROJECTS

Новини

Плевенска инициатива: посещение на проекти

На 4 октомври международните фасилитатори мадам Шийла Куин, д-р Ян Соботка, г-жа Шийла Мърфи, д-р Катаржина Брочек и г-жа Гидре Донаускайте посетиха проекти от Инициатива Плевен на програмата “Решаване на проблеми за по-добро здраве”.

“Астма” център.

Центърът е в сградата на ДКЦ –2. Открит през 1995 година, той е известен сред населението и медиците в Плевен. Дейностите по всички проекти, свързани с астма и белодробни болести, са координирани с центъра, както и с фондация “Бял дроб”, основана скоро след откриването на Центъра.

Всички проекти от “Плевенска инициатива” са се обединили в усилията си за постигане подобряване на здравето, качеството на живот и страданието на своите пациенти, както и за предпазване от белодробни болести.

Регистрираните за проследяване и лечение пациенти са около 2000. Изградена е и база данни /находки при преглед, диагноза, назначено лечение, продължителност на периодите на нетрудоспособност и хоспитализация, посещения в центъра за бърза помощ и др.

Екипът на центъра работи в сътрудничество с общопрактикуващите лекари, фармацевтични фирми, здравно-осигурителната каса, местния бизнес, местните здравни власти. Неотдавна центърът се оборудва с нова апаратура за около 10 хиляди долара.

Екипът на д-р Явор Иванов – д-р Пламен Павлов, д-р Павлина Глоговска, д-р Цаня Попова, д-р Стела Вулова, д-р Елена Петкова, дава добър пример за колеги от други градове. Подобни програми са стартирали във Видин, Враца, Русе и Троян.

Младежки превантивен център

Първият проект, свързан с употреба на наркотици от подрастващи, е за оценка на епидемиологичната обстановка в Плевен, е стартиран през 1995 година от доц. Мария Александрова. През следващата година тя стартира програма, насочена към превенция и повишаване на чувствителността към проблема. Започната бе широка кампания за здравна просвета сред учениците на възраст 14-19 години, проведоха се беседи, срещи и семинари за родители, учители, лекари и медицински сестри, журналисти от местните медии. Осигурени са и образователни материали – брошури, листовки, видеофилми.

Местните медии оказват помощ на програмата с публикации, телевизионни и радио програми. През 1997 година Галя Маринова издава “Наркомани разказват”, а през 1999 година, по проект в рамките на “Плевенска инициатива”, тя издава втори сборник разкази - “Билет за никъде”, които запознават младите читатели със съдбите на жертви на наркотици и СПИН. И двете книги са представяни пред младежи в Плевен, Русе, Видин, Габрово, Силистра, Ловеч... . И двете книги имат успех след младата читателска публика.

Постепенно програмата се разраства. Г-жа Павлина Жекова работи по проект, насочен към експериментиращите с наркотици подраст-ващи. Валентин Иванов от фондация “Плевен 21 век” организира програма за обмяна на игли и спринцовки за предпазване на употребяващите наркотици от хепатит B и C.

През 1999 година плевенският исторически музей, съвместно с Община Плевен, РДВР – Плевен, фондация “Отворено общество”, клуб “Отворено общество” – Плевен, плевенската асоциация за борба с наркоманиите сред младежите подреди изложба “Заедно срещу дрогата”. Изложбата е посетена от около 15 000 ученици от Плевен, и е показана в редица градове на България.

В рамките на “Плевенска инициатива” д-р Цветелина Виткова от ХЕИ – Плевен стартира образователна програма за вредата от наркотиците в две училища, а отдел “Промоция на здравето” проведе епидемиологично проучване и разпространи здравно-просветни материали сред подрастващите в плевенски регион.

Няколко неправителствени организации от Плевен и община Плевен организираха хепънинг на централния площад в Плевен.

Община Плевен осигури помещения в Младежки дом, където от септември 2000 действа превантивният център. Психиатри, психолози, социални работници, студенти, учители работят заедно за превенция на наркоманиите, ранна намеса в случаи на експериментиране, ресоциализация при лекували се наркомани. На горещата телефонна линия – 290-84 се дават консултации на нуждаещите се от съвет по проблема.

Резултатите от проучването, проведено през май 2000 г. В Плевен показват, че общият брой на употребяващите редовно и епизодично наркотици сред младежите е 8%. Някои проучвания сочат, че в други региони процентите на вземащите наркотици са се увеличили с 15 – 20%. В сравнение с 1995 година, броят на младежите наркомани се е увеличил с 1.5%, и само 3% от употребяващите са зависими.

През периода 1995-2000 не е регистриран смъртен случай вследствие на свръхдоза. Досега сред наркоманите не е открит серопозитивен, и само единици са заразени с хепатит B и C.

Детска ясла “Щастливо детство”

Тук са завършени три проекта. През 1999 година г-жа Елисавета Бочева завърши успешно проект, целящ съкращаване на времето за адаптация на новоприетите деца.

В рамките на “Плевенска инициатива” бяха завършени два нови проекта.

С проекта си г-жа Денка Мачева цели физическо укрепване на децата, и така да снижи инфекциите на горните дихателни пътища. В сравнение с предходен период (юни 1998- юни 1999), броят на епизодите през периода юли 1999- юни 2000 е намалял с 22%.

По време на посещението фасилитаторите видяха новоприета група деца, с които през септември е стартирана същата програма. Към програмата от упражнения са прибавени нови упражнения за релаксация. Родителите вземат активно участие в програмата с помощта си при организиране на състезания, изготвяне на видеофилми с инструкции какви упражнения могат да се правят с децата вкъщи. Към програмата са проявили интерес други две ясли в града.

Г-жа Иванка Радева, сурдопедагог, стартира програма за ранно откриване на деца със слухови увреждания с цел навременна рехабилитация. Девет новодиагностицирани деца са приети в центъра. Той се намира в яслата, което допринася за тяхната интеграция: само по време на специализираните занятия децата не са заедно с останалите деца от яслата.

Рехабилитацията и проследяването на децата с увреден слух продължава и след постъпването на децата в масовите детска градина и училища. Родителите на децата се обучават как да работят с тях и вкъщи. .

Г-жа Радева работи в тясно сътрудничество с оториноларинголози, Съюза на глухите в България, социалните служби и с общопрак-тикуващите лекари.

Институтски онкологичен център - Плевен

Екип от центъра - доц. Ташко Делийски, д-р Румен Стоянов и д-р Георги Байчев поставят началото на локална скринингова програма за ранна диагностика на рак на гърдата, като активно се издирват фамилно обременените жени. Кампанията включва беседи по местното радио, срещи в местни предприятия, в които работят предимно жени, разпространение на брошури, листовки, излъчване на видеофилми по местните телевизии с информация за заболяването и начините на самоизследване. Резултати: за преглед са се явили 2703 жени, от които 42 са насочени за лечение, а 1412 с бенигнена патология са регистрирани за проследяване.

През 1999 година е стартирана и програма, целяща ранно откриване на рак на маточната шийка. Координаторът д-р Славчо Томов отчете резултатите през юни 2000 г. Сега той планира да продължи програмата в сътрудничество с общопрактикуващите лекари.

Екипите на всички проекти от центъра работят съвместно с фондация “Роберт Гайзер – Здраве за жената”, катедрите на ВМИ – Плевен, Националния център по онкология, неправителствени организации, колеги от страната. Резултатите от програмите са представяни на форуми в страната и чужбина.

По време на посещението в центъра се проведе и кратка среща с проф. Иван Черноземски, директор на НОЦ. Той оценява програмите като добър пример как може да се подобри работата по навременната диагностика на рака.

От 6 до 8 октомври в Габрово се проведе семинар “Инициатива за по-добро здраве –Габрово”. Той бе организиран от Лекарски съюз – Габрово и клубове “Отворено общество”- Плевен и Габрово, в сътрудничество с Областната управа, Районния център по здравеопазване, ХЕИ, МБАЛ – Габрово и местни неправителствени организации.

Преди семинара с помощта на местните медии представиха програмата и насърчиха жителите на Габрово да определят най-важните здравни проблеми и да участват в разрешаването им заедно с медицинските специалисти, местните власти и неправителствени организации.

Пред участниците в семинара приоритетните здравни проблеми на Габрово и региона, с оглед на реформата в здравеопазването, представи д-р Бончо Бонев, директор на РЦЗ - Габрово. Участниците бяха приветствани от д-р Нина Дамянова, заместник – областен управител на Габровска област. Своята подкрепа за инициативата даде и д-р Михаил Карафезов, народен представител от Габрово. В работата на семинара участва и д-р Страшимир Генев от НЗОК.

Участниците в семинара работиха по проектите си в пет групи, с помощта на международните фасилитатори Мадам Шийла Куин (Англия), д-р Ян Соботка и д-р Катаржина Брочек (Полша), г-жа Шийла Мърфи (Англия), г-жа Гидре Донаускайте (Литва), и българския екип – д-р Аспарух Георгиев, доц. Мария Александрова, д-р Камен Каменов, доц. Гена Грънчарова, д-р Явор Иванов, д-р Анжелика Велкова и г-жа Янка Цветанова. Бяха разработени 47 проекта, и бяха установени връзки между проектите като възможности за съвместна работа в области като здравна просвета за деца и техните родители, ранна диагностика на рака, предпазване от и ранна рехабилитация на социално-значими заболявания, обучение на пациенти, подобряване на болничните грижи, подобряване на качеството на живот в социални заведения, подобряване на околната среда, интеграция на инвалиди, превенция на самоубийствата и др.

След семинара бе сформиран местен организационен комитет: д-р Антоанета Стойкова,г-н Томислав Дончев, д-р Божидар Паралчев, г-жа Мариана Проданова, г-жа Ели Маринова и д-р Севдалина Йотева.

Проектите по “Инициатива за по-добро здраве за Габрово“ включват:

Адриан Василев - Подобряване на хигиената и частично залесяване на територията на студентските общежитията на Технически университет - Габрово

Антоанета Стойкова, Божидар Паралчев, Тодор Шандурков, Красимир Паралчев - Комплексна програма за превенция на социално значими заболявания: артериална хипертония, диабет, заболявания на щитовидната жлеза, дислипидемии, колоректален рак сред 800 работници от габровски фирми

Ася Пейкова, Наталия Иванова - Програма за социализация и ресоциализация на инвалиди в гр. Севлиево

Божидар Петров - Образователна програма за усложненията от употреба на психоактивни вещества за студенти от Технически университет в Габрово

Галя Влаева - Организиране на рехабилитация за инсултно болни у дома след прекаран инсулт

Ганка Димитрова - Програма за проследяване и обучение на 40 пациенти след прекаран ОИМ

Георги Георгиев - Организиране на трудотерапия за съхранените обитатели на дом за стари хора в с. Добромирка

Георги Иванов - Въвеждане в практиката на еднодневна /амбулаторна/ хирургия в практиката на МБАЛ - Габрово

Димитър Цанков - Подобряване ранната диагностика на рак на гърдата

Дора Чернева - Подобряване ранната профилактика на пост-травматичната остеопороза на жени на възраст 40-55 години в района на диагностично-консултативен център –2 в гр. Габрово

Евелина Пенкова - Здравно-образователна програма по здравни проблеми за слушателите на Радио Габрово

Екатерина Боева - Обучение на персонала на дом за деца и юноши в Севлиево за подобряване качеството на храната, приготвяна в дома

Елиза Ковачева - Популяризиране на дейността по програма за превенция на самоубийствата

Иванка Младенова - Здравно-образователна програма за пациенти прекарали остър инфаркт и техните близки

Иванка Сярова - Програма за намаляване на чревните паразитози сред децата от дом за деца и юноши - Габрово

Илияна Донкова - Програма за подобряване на социализацията на децата /0 - 3 г/ от Дом за медико- социални грижи за деца в Габрово

Катерина Никифорова - Организиране на профилактични офталмологични прегледи за ранна диагностика на някои заболявания сред населението на с. Крамолин, община Севлиево

Клавдия Чобанова - Обучителна програма за пациенти с новооткрит диабет

Красимир Дончев - Подобряване на ранната диагностика на рак на белия дроб

Мариана Ванкова - Програма за намаляване на жертвите на домашно насилие над деца и жени в Габрово

Мариана Станкова,Анелия Розенова - Отдиференциране на спешните от рутинните изследвания и подобряване на колаборацията между клинична лаборатория и отделенията на МБАЛ - Габрово

Мая Колева - Здравно-образователна програма за деца на възраст от 11 до 14 години за вредата от наркотични вещества

Милена Димитрова - Организиране на извънкласна дейност за социално интегриране на 11 деца със зрителни увреждания в Габрово

Мирослав Пантев - Здравно-просветна програма за намаляване на бременностите и ражданията преди 17 годишна възраст сред ромското население на Габрово

Мирослав Стоянов - Подобряване качеството на проследяване и терапия на прекарали остър инфаркт на миокарда

Мирослава Иванова - Осигуряване на по-добри условия на живот и лечение в дом за стари хора с деменция в гр. Дряново

Невена Иванова - Подобряване на ранната диагностика на преобладаващите заболявания всред децата от ранна училищна възраст /7-10 г / сред децата от Габрово

Нели Тодорова - Организиране на компютърно обучение на 40 медицински сестри от МБАЛ - Габрово

Нелия Иванова - Обучение на родителите на 100 деца в принципите на здравословно хранене

Нина Дамянова, Томислав Дончев - Организиране на дейността на хоспис в Габровска област

Пенка Йотева - Програма за превенция на пушенето сред деца на възраст от 8 до 15 години в ОУ “Неофит Рилски в гр. Габрово

Петя Тошкова - Организиране на лечебна физкултура за децата с неправилна стойка и гръбначни изкривявания

Полина Паралчева - Комплексна програма за скрининг и превенция на мозъчно-съдови малформации сред 800 работници от габровски фирми

Радка Галова - Подобряване качеството на грижите за болните в хирургическо отделение: намаляване на вътреболничните инфекции

Румяна Рашева - Изграждане на група за взаимопомощ за родители с деца страдащи от онкологични заболявания

Светла Григорова - Програма за социална интеграция на деца с ДЦП

Светлана Борисова, Бистра Камбурова - Организиране на ранна рехабилитация на рискови новородени деца в Габрово

Севдалина Йотева - Събиране на информация за причините за самоубийствата в Габровска област и откриване на телефонна линия

Слави Атанасов - Комплексна програма за предотвратяване на слуховите травми сред децата до 18 години на територията на гр. Габрово

Снежана Георгиева - Създаване на сестринска група за здравни грижи за терминално болни и прекарали остри сърдечни заболявания по домовете

Станка Борисова - Здравно-просветна програма за ранно диагностициране на рак на гърдата и психотерапевтична помощ за оперираните жени в Габрово

Стела Благоева - Излъчване на здравна радиопрограма и осигуряване на психологична помощ чрез откриване на телефон за психологическа помощ за превенция на суицидните действия в Габрово

Стефка Рачева - Здравно-образователна програма и изгражда не на групи за взаимопомощ и обучение за инвалиди от гр. Габрово

Христина Георгиева - Обучителна програма за близките на пациенти с тежки aлергии за поведение при спешни ситуации

Христина Панова - Комплексна здравно-образователна програма за децата от 12 до 18 годишна възраст в гр. Габрово

Ценислав Влъкненски - Организиране на школи по танци за коригиране на плоскостъпие и изграждане на правилна стойка на тялото -

Юлия Ненова - Подобряване на ранната диагностика на туберкулозата

В следващия брой очаквайте:

- информация за посетени проекти и семинар за проследяване на проекти по програмата за превенция на наркомании във Варна на 23 и 24 октомври;

- информация за посетени проекти и семинар за проследяване на проекти на студенти от Факултет по здравни грижи на ВМИ - Плевен , проведен на 26 октомври;

- информация за посетени проекти и семинар за проследяване на работата по проекти от “Русенска инициатива” на програмата “Решаване на проблеми за по-добро здраве”.

news

Site visits: Pleven Initiative for Better Health Projects

On October 4th, the team of international facilitators - Dame Sheila Quinn, Dr. Jan Sobotka, Ms. Shelagh Murphy, Dr. Katarzyna Broczek and Gidre Donauskaite, Bulgarian PSBH team visited projects in Pleven.

Asthma center

It is on the premises of a Diagnostic and Consulting Center in Pleven. The asthma center was opened in 1995, and has been recognized by the community and medical professionals. All asthma-and lung-disease related projects that have been implemented and/or completed have coordinated their activities with the center, and the Pleven Lung Disease Foundation that was registered not long after the center was started.

All projects from the Pleven Initiative have joined efforts, and have set a program that has achieved a lot to improve health and quality of life, prevent disease and relieve suffering.

About 2000 asthma patients have been registered for follow-up and treatment. Data base includes all patients that visit the center, and information that covers findings on examination, diagnosis, treatment, days off work, appointments for check-ups, visits to the emergency hospital, length of hospital stay, etc.

The team works in close collaboration with pharmaceutical firms, the Health Insurance Fund, local business, local health authorities. Lately, new equipment was provided for $10,000.

The team of Dr. Yavor Ivanov (Dr. Plamen Pavlov, Dr. Pavlina Glogovska, Dr. Tsanya Popova, Dr. Stella Voulova, Dr. Elena Petkova) is a good example for their colleagues who have started similar activities in Vratza, Vidin, Rouse, and, recently, Troyan.

Drug Abuse Prevention Center

The first drug abuse-related project was implemented in 1995 by Assoc. Prof. Maria Alexandrova who wanted to assess the situation in Pleven. The next year she started a program, oriented to prevention and raising the awareness on the problem. A broad campaign was started, which included health education for students aged 14-19, and talks, meetings and workshops for their parents, schoolteachers, doctors and nurses, and journalists from the local media. Educational materials were provided - brochures, leaflets, and video films.

The local media assisted her in her efforts with publications, TV and radio talks. In 1997, Mrs. Galya Marinova, the leader of another project published “Eleven Stories of Drug Addicts”, and in 1999, after participating in the Pleven Initiative of the PSBH workshop, she published a second collection of stories - “A Ticket to Nowhere”, aiming at raising the awareness of young people on HIV and drugs. Both books have been presented during meetings with students in Pleven, Rouse, Vidin, Gabrovo, Silistra, and Lovetch, to mention only a few. Over 30 thousand copies of both books have reached the hearts and minds of young readers.

Gradually, new people and organizations joined the program:

· Mrs. Pavlina Zhekova, a nurse, worked on the prevention of experimenting with drugs by adolescents

· Mr. Valentin Ivanov from “Pleven – 21st century” Foundation organized an exchange of needles program to prevent hepatitis B and C infections in users.

· Pleven Museum of Natural History, in collaboration with the Municipality of Pleven, Pleven police juvenile delinquency department, Open Society Fund and Open Society Club in Pleven, arranged an exhibition “ Together against Drugs”, seen by some 15,000 students in Pleven. The exhibition has been shown in many towns of Bulgaria.

· Dr. Tzvetelina Vitkova of the Pleven Hygiene and Epidemiology Station started an educational program on the harmful effect of drugs in two schools.

· The health promotion department at the Hygiene and Epidemiology Station carried out an inquiry and distributed educational materials among adolescents in the Pleven region.

· Several NGOs organized a happening on June 26 in collaboration with the Municipality of Pleven.

The municipality provided rooms that now house the Drug Abuse Preventive Center. Psychiatrists, psychologists, social workers, medical students and teachers carry out activities that aim at preventing drug abuse, early intervention in cases of experimenting, and social reintegration of addicts after treatment. The hot telephone line will provide consultations to those in need of advice on the problem. The center is on the premises of a youth center, where adolescents, university students also visit the computer clubs, a disco, and attend other activities organized by and for the young population of Pleven.

Results:

· Inquiries carried out in Pleven in May 2000 showed that the number of adolescent users is 8%. Some studies quote percentages of increase as high as 15-20% for other regions. As compared to 1994, in Pleven adolescent drug addiction has increased by 1.5%, and only 3% of all these are addicted.

· No death cases have been registered due to overdose, intoxication or suicide associated with drug use.

· No HIV- positive cases have been detected among drug users.

· There are only a few heroin addicts diagnosed with hepatitis B and C.

“Happy Childhood” Creche

Three projects have been implemented and completed there.

In 1999, Ms. Elisaveta Bocheva completed a project that aimed at shortening the period for adaptation of newly admitted toddlers.

Within the Pleven Initiative, two other projects were implemented and completed. Mrs. Denka Macheva aimed at improving physical fitness of children aged 1-3, thus reducing upper respiratory infections. As compared to a previous period (June 1998- June 1999), the rate of infections was decreased by 22% between June 1999 and June 2000.

During the visit, facilitators saw the newly admitted group, with whom the same program was started in September 2000. New exercises for relaxation were added to the set of exercises. Parents take active part in the program, helping organize competitions, production of videos with instructions what exercises can be performed when the children are at home. Two other creches in Pleven have shown interest in the projects.

Mrs. Ivanka Radeva, a specialist in rehabilitation for children with hearing disabilities, organized a screening program, aiming to diagnose such children and start early rehabilitation. Nine children were included in the group for early rehabilitation. The rehabilitation center is on the premises of the crиche, which contributes to the process of integration: it is only during the training sessions that the children are not with the other children attending the creche.

Rehabilitation and follow-up continues after the children leave the crиche to go to kindergartens and to school.

Parents are trained how to work with their children in the home. Mrs. Radeva works in close collaboration with ENT specialists, the Union of People with Hearing Disabilities, social services, and, of late, with GPs.

University Center of Oncology - Pleven

A team of the center - Assoc. Prof. Tashko Deliiski, Dr. Roumen Stoyanov and Dr. Georgi Baichev started a regional program aimed to early detect breast cancer, and encourage women at risk to turn up and be registered for follow-up. The broad campaign included radio talks, meetings at local factories where employees are mostly women, distribution of brochures, leaflets on the disease and methods of self-examination, videos shown on the local TVs. Results: 2703 women turned up, of whom 42 were referred for treatment, and 1412 were diagnosed with benign pathology and registered for follow-up.

Another program was started in 1999: early detection of cervix cancer. Dr. Slavcho Tomov reported the results at the follow-up in June 2000. The results he reported in June 2000 are encouraging, and he is now planning to continue the program in collaboration with GPs.

The team works in close collaboration with the “Robert Geiser - Health for Women” Foundation, various departments of the Medical University in Pleven, the National Center of Oncology, NGOs, colleagues from other towns. Results from the program have been reported at various meetings in the country and abroad.

The project coordinators, international and local PSBH team had a short meeting with Prof. Ivan Chernozemski, director of the National Center of Oncology in Sofia. He stated his opinion on the programs as a good example of what can be done to improve on early detection of cancer.

Gabgovo Initiative of the PSBH Program

A Problem Solving for Better Health Initiative workshop took place in Gabrovo on October 6 – 8, 2000. The workshop was organized by the Gabrovo Association of Physicians, the Open Society Clubs in Gabrovo and Pleven, in collaboration with the Gabrovo Regional Government, the Regional Health Center, Hygiene and Epidemiology Station, Gabrovo Regional Hospital and local non-governmental organizations.

Prior to the workshop, a campaign was started in the local newspapers, radios and TVs to promote problem solving for better health, and encourage Gabrovo citizens to identify priorities health issues and become engaged in solving with medical professionals, local authorities and NGOs.

The health situation in Gabrovo in view of the ongoing health reform and priorities in solving health problems was presented by Dr. Boncho Bonev, Director of Regional Health Center. Dr. Nina Damyanova, Deputy Governor, addressed the participants. Dr. Strashimir Genev, a representative of the National Health Insurance Fund, attended the workshop and the initiative had the moral support of Dr. Mikhail Karafezov - Member of Parliament, elected in the Gabrovo region,

The participants worked on their plans of action in five groups, and assisted by the international facilitators Dame Sheila Quinn (UK), Dr. Jan Sobotka and Dr. Katarzyna Broczek (Poland), Ms. Shelagh Murhy (UK), Ms. Gidre Donauskaite (Lithuania), and the local facilitators Assoc. Prof. Gena Grancharova, Assoc. Prof. Maria Alexandrova, Dr. Kamen Kamenov, Dr. Yavor Ivanov, Dr. Asparuh Georgiev, Dr. Anjelika Velkova and Mrs. Yanka Tzvetanova.

Fourty-seven plans of action ere prepared, and linkages between projects came only naturally: health education for children and their parents, early detection of cancer, prevention and early rehabilitation of socially relevant diseases, patient education, improving quality of hospital care, improving the quality of life in orphanages, improving environment, integration of disabled people, prevention of suicide.

After the workshop, a local team was built: Dr. Antoaneta Stoikova, Mr. Tomislav Donchev, Dr. Bozhidar Paralchev, Mrs. Mariana Prodanova, Mrs. Eli Marinova and Dr. Sevdalina Yoteva.

The following plans of action were prepared:

Mrs. Assya Peikova, Mrs.Natalia Vassileva - A program to allow for better social integration and reintegration of disabled people in Sevlievo

Dr. Antoaneta Stoikova, Dr. Bozhidar Paralchev, Dr. Todor Shandourkov, Dr. Krassimir Parlchev - A program to detect and/or prevent socially relevant diseases (AH, diabetes, disorders of the thyroid gland, lipidemias, colorectal cancer) among 800 e employees in firms in Gabrovo

Dr. Dimitar Tzankov - Improving early diagnosis of breast cancer

Dr. Dora Cherneva - Timely rehabilitation program for post-traumatic osteoporosis in women aged 40-55

Dr. Ekaterina Boeva - Training the staff of the orphanage in Gabrovo to improve the quality of food prepared for the children

Dr. Galya Vlaeva - Organizing rehabilitation for stroke patients in their home

Dr. Georgi Ivanov - Introduction into practice of one-day surgery in the Gabrovo Regional Hospital

Dr. Ivanka Syarova - A program to reduce the ascaridiasis in children in an orphanage in Gabrovo

Dr. Krassimir Donchev - Improving early detection of lung cancer

Dr. Miroslav Stoyanov - Improving the quality of follow-up and treatment for patients with AMI

Dr. Nelia Ivanova - Teaching the parents of 100 children of ages 3 to 7 the principles of proper dietary regimen

Dr. Nina Damyanova, Deputy Governor, Mr. Tomislav Donchev - Organizing the activities of a hospice in Gabrovo Region

Dr. Paulina Paralcheva - A program for early detection and prevention of cerebrovascular malformations for 800 employees in firms in Gabrovo

Dr. Sevdalina Yoteva - Collecting information on the causes for suicides and suicidal attempts in the region of Gabrovo and opening a hot telephone line

Dr. Slavi Atanassov - A complex program to prevent hearing impairments among children in Gabrovo

Dr. Stanka Borissova - Health education to improve early diagnosis of breast cancer and psychotherapeutic aid for women operated on for the condition

Dr. Svetlana Borissova, Dr. Bistra Kambourova - Organizing early rehabilitation for newborns at risk in Gabrovo

Mr. Adrian Vassilev -Improving hygiene and planting trees on the campus of the University of Engineering in Gabrovo

Mr. Bozhidar Petrov - Education on complications from drug use for students of the University of Engineering in Gabrovo

Mr. Georgi Markov - Organizing occupational therapy for the physically preserved inhabitants of a home for elderly people

Mr. Miroslav Pantev - Health education to prevent teenage pregnancies among Roma population in Gabrovo

Mr. Tsenislav Vlaknenski - Organizing groups in a dancing school to correct mild foot deformities and incorrect posture

Ms. Christina Georgieva - Educating for the relatives of patients with severe allergies how to act in emergency situations

Ms. Christina Panova - Health education for children of Gabrovo aged 12-18

Ms. Eliza Kovacheva - Informing the population of Gabrovo about the program aimed at prevention of suicides and suicide attempts

Ms. Evelina Penkova - An educational program for the audience of Radio Gabrovo on health issues

Ms. Ganka Dimitrova - Improving follow-up and treatment of 40 AMI patients

Ms. Iliana Donkova - A program to socialize children aged up to 3 in an orphanage in Gabrovo

Ms. Ivanka Mladenova - Health education for AMI patients and their relatives to prevent acute states

Ms. Katerina Nikiforova - Organizing ophthalmologic examinations for early detection of disorders in the village of Kramolin, Gabrovo region

Ms. Klavdia Chobanova - Education for newly diagnosed patients with diabetes

Ms. Mariana Stankova, Ms. Anelia Rozenova - Improving differentiation of routine from emergency investigations and collaboration between clinical lab and departments in Gabrovo Regional Hospital

Ms. Mariana Vankova - A program to prevent violence in the home in Gabrovo

Ms. Maya Koleva –A health education on the dangers of drug use for children aged 11-14 in one middle school in Gabrovo

Ms. Milena Dimitrova - Organizing activities to improve on social integration of 11 partially blind children attending regular school in Gabrovo

Ms. Miroslava Ivanova - Providing better life conditions and treatment for the inhabitants of a home for demented elderly people in Dryanovo by fund raising

Ms. Nelly Vassileva - Organizing computer classes for 40 nurses working at the Regional Hospital in Gabrovo

Ms. Nevena Ivanova - Improving of early diagnosis of prevalent diseases among children aged 7-10 in Gabrovo

Ms. Penka Yoteva – An anti-smoking program for children aged 8-15 in Neophit Rilski middle school in Gabrovo

Ms. Petya Toshkova - Organizing remedial gymnastics for children with incorrect posture and mild spinal deformities

Ms. Radka Galova - Improvement the quality of care in the surgery ward and reduction of nosocomial infections

Ms. Roumyana Rasheva - Organizing a support group for parents of children with oncological diseases

Ms. Snezhana Georgieva - Building a team of nurses to provide care for AMI and terminal patients in their homes

Ms. Stefka Racheva -A health education program within support groups among disabled people in Gabrovo

Ms. Stella Blagoeva - Health educational program to raise the awareness of the citizens of Gabrovo on suicide and suicide attempts by broadcasting special programs and opening a green line for those in need of psychological help

Ms. Svetla Grigorova - A program for social integration of children with cerebral palsy

Ms. Yulia Nenova - Timely detection of, and treatment for tuberculosis in Gabrovo

In the next issue:

- site visits and follow-up workshop of Drug Abuse Prevention PSBH projects in Varna - October 23 and 24;

- site visits and follow-up workshop for projects of students of the Faculty of Nursing of Medical University in Pleven - October 26;

- site visits and follow-up workshop for projects from “Rouse Initiative “ of the Problem Solving for Better Health program - October 28.

Medline Information

Nosocomial Infections / Вътреболнични инфекции

TI: Use of antibiotic exposure to detect postoperative infections.

AU: Yokoe-DS; Shapiro-M; Simchen-E; Platt-R

SO: Infect-Control-Hosp-Epidemiol. 1998 May; 19(5): 317-22

AB: OBJECTIVE: To assess the utility of postoperative antibiotic exposure as an indicator of postoperative infection after coronary artery bypass graft surgery. DESIGN: We determined an optimal antibiotic exposure threshold by creating receiver operating characteristic curves. SETTING: Tertiary healthcare institution (United States); national sample (Israel). PATIENTS: 5,887 patients undergoing coronary artery bypass graft surgery. RESULTS: Postoperative antibiotic exposure with at least 9 days between the first and last dates of antibiotic administration, excluding the first postoperative day, had a sensitivity of 95% (261/276) and specificity of 85% (3,944/4,628) for identifying surgical-site infection, using as a gold standard surgical-site infections identified by conventional prospective surveillance or extrapolated from review of a sample of medical records. In contrast, using the same gold standard for surgical-site infections, the sensitivity of routine prospective surveillance alone was only 60%. The predictive value positive of the defined antibiotic exposure was 28% (261/945) for surgical-site infection and 60% (563/945) for any nosocomial infection. In the Israeli cohort, the sensitivity was 87% (74/85) and the specificity was 82% (735/898). CONCLUSION: Antibiotic exposure of sufficient duration and timing was more sensitive than conventional methods in detecting nosocomial infection and required substantially less effort to collect. Although the predictive value positive for surgical-site infection was only moderate, the majority of individuals identified this way had a nosocomial infection.

TI: [Pefloxacin + metronidazole versus netilmicin + metronidazole in the prevention of nosocomial infections in contaminated surgery. Pefloxacin Study Group]

AU: Germiniani-R; Montorsi-W

SO: Minerva-Chir. 1998 Jan-Feb; 53(1-2): 103-12

AB: Pefloxacin plus metronidazole versus netilmicin plus metronidazole in the prevention of nosocomial infections during contaminated surgery. Surgical prophylaxis is widely used in contaminated surgery, especially colorectal surgery. In this clinical trial the efficacy of pefloxacin 800 mg i.v. slow infusion associated to metronidazole 500 mg i.v. 1-2 hours before surgery and then metronidazole alone after 6 and 12 hours versus netilmicin 200 mg i.m. associated to metronidazole 500 mg i.v. 1-2 hours before surgery and then both after 6 and 12 hours were evaluated in 97 patients suffering by colorectal surgery. Efficacy of prophylaxis in patients was evaluated in terms of appearance of post-surgical infections (abdominal, urinary, respiratory and wound infections). In pefloxacin + metronidazole group (53 patients), two cases of wound infections (3.8%) and three cases of respiratory infections (5.8%) were observed. In netilmicin + metronidazole group (44 patients), two cases of wound infections (4.9%), three cases of urinary infections (7%), three cases of respiratory infections (7. 5%) and one case of intra-abdominal infection were observed. Our data confirmed that in colorectal surgery, the association pefloxacin, drug with microbiological and pharmacokinetics characteristics suitable for prophylaxis + metronidazole, active against anaerobes pathogens, prevents post-surgical infections as well as a reference association (netilmicin + metronidazole), with the advantage of a single administration.

TI: [Pefloxacin versus ceftriaxone in single-dose antibiotic prophylaxis in general clean-contaminated surgery. The Pefloxacin Study Group]

AU: Montorsi-W; Germiniani-R

SO: Minerva-Chir. 1997 Dec; 52(12): 1539-48

AB: Single-shot surgical prophylaxis is today used in all clean-contaminated surgery, because it is able to reduce the incidence of post-surgical infections. The aim of this clinical trial is to evaluate the efficacy of Pefloxacin 800 mg i.v. slow infusion in single administration 1-2 hours before surgery versus ceftriaxone 2 g i.v. 1-2 hours before surgery in 297 patients suffering from clean-contaminated surgery, especially biliary surgery and gastrectomy. Efficacy of prophylaxis in 259 patients, evaluable according to the protocol, was evaluated in terms of appearance of post-surgical infections (urinary, respiratory and wound infections). In the Pefloxacin group (128 patients), no cases of wound infections were observed, except one case of wound sterile secretion, without dehiscence, (0.81%), one case of urinary infection (0.81%) and three cases of respiratory infections (2.34%). In the ceftriaxone group (131 patients), three cases of wound sterile secretion without dehiscence (2.36%), one case of urinary infections (0.76%) and four cases of respiratory infections (3.05%) were observed. From this study we can conclude that single-shot surgical prophylaxis with pefloxacin, drug with microbiological and pharmacokinetics characteristics suitable for prophylaxis, is able to prevent postsurgical nosocomial infections as well as ceftriaxone, considered a reference drug largely used in this indication.

TI: New approaches to reduce Staphylococcus aureus nosocomial infection rates: treating S. aureus nasal carriage.

AU: Perl-TM; Golub-JE

SO: Ann-Pharmacother. 1998 Jan; 32(1): S7-16

AB: BACKGROUND: Nosocomial infections cause significant patient morbidity and mortality. The 2.5-million nosocomial infections that occur each year cost the US healthcare system $5 million to $ 10 million. Staphylococcus aureus has long been recognized as an important pathogen in human disease and is the most common cause of nosocomial infections. OBJECTIVE: To describe the epidemiology of S. aureus nosocomial infections that are attributable to patients’ endogenous colonization. DATA SOURCES: Review of the English-language literature and a MEDLINE search (as of September 1997). DATA SYNTHESIS: The ecologic niche of S. aureus is the anterior nares. The prevalence of S. aureus nasal carriage is approximately 20-25%, but varies among different populations, and is influenced by age, underlying illness, race, certain behaviors, and the environment in which the person lives or works. The link between S. aureus nasal carriage and development of subsequent S. aureus infections has been established in patients on hemodialysis, on continuous ambulatory peritoneal dialysis, and those undergoing surgery. S. aureus nasal carriers have a two-to tenfold increased risk of developing S. aureus surgical site or intravenous catheter infections. Thirty percent of 100% of S. aureus infections are due to endogenous flora and infecting strains were genetically identical to nasal strains. Three treatment strategies may eliminate nasal carriage: locally applied antibiotics or disinfectants, systemic antibiotics, and bacterial interference. Among these strategies, locally applied or systemic antibiotics are most commonly used. Nasal ointments or sprays and oral antibiotics have variable efficacy and their use frequently results in antimicrobial resistance among S. aureus strains. Of the commonly used agents, mupirocin (pseudomonic acid) ointment has been shown to be 97% effective in reducing S. aureus nasal carriage. However, resistance occurs when the ointment has been applied for a prolonged period over large surface areas. CONCLUSIONS: Given the importance of S. aureus nosocomial infections and the increased risk of S. aureus nasal carriage in patients with nosocomial infections, investigators need to study cost-effective strategies to prevent certain types of nosocomial infections or nosocomial infections that occur in specific settings. One potential strategy is to decrease S. aureus nasal carriage among certain patient populations.

TI: Antibiotic-resistant gram-positive cocci: implications for surgical practice.

AU: Barie-PS

SO: World-J-Surg. 1998 Feb; 22(2): 118-26

AB: Gram-positive infections are causing more serious infections than ever before in surgical patients, who are increasingly aged, ill, and debilitated. Invasive procedures disrupt natural barriers to bacterial invasion, and indwelling catheters may act as conduits for infection. The use of broad-spectrum antibiotics selects for the emergence of resistant pathogens. Potential sites of nosocomial gram-positive infections include the urinary tract, surgical site (including prosthetic devices), intravascular loci, lung and pleural space, facial sinuses, and peritoneal cavity. Responsible organisms include species from the genera Enterococcus and Staphylococcus. Methicillin-resistant strains of Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) emerged during the 1970s, leading to a marked increase in the use of vancomycin as the treatment of choice. Vancomycin use, in turn, has been implicated (along with widespread cephalosporin use) in the emergence of vancomycin-resistant enterococci (VRE) during the 1990s. Of great concern is the likely emergence of vancomycin-resistant staphylococci, which would constitute a public health emergency. Vancomycin remains the treatment of choice for infections caused by MRSA/MRSE, but rampant inappropriate use (e.g., prophylaxis in non-penicillin-allergic patients, treatment of methicillin-sensitive strains) must be curtailed. Chloramphenicol is increasingly the treatment of choice for serious VRE infections. Infection control policy must also minimize the possibility of transmission. All infected or colonized patients should be isolated and all environmental surfaces considered contaminated. Disposable gloves are mandatory for all patient contact, even incidental contact, and must be disposed of after each patient encounter. Hand-washing (the single most effective infection control measure) is mandatory after glove disposal. Gowns should be worn for direct contact with infected patients and masks used when aerosolization or splashing of secretions is likely.

TI: Acute paranasal sinusitis in critically ill patients: guidelines for prevention, diagnosis, and treatment.

AU: Talmor-M; Li-P; Barie-PS

SO: Clin-Infect-Dis. 1997 Dec; 25(6): 1441-6

AB: Nosocomial sinusitis is common in critical illness. Randomized trials indicate that radiographic sinusitis (RS) occurs in 25%-75% of all critically ill patients and that 18%-32% of endotracheally intubated patients will develop sinusitis. Variability in the estimated incidence of RS stems from the many radiographic techniques used for diagnosis. Critically ill patients with suspected sinusitis should undergo computed tomographic scanning of all paranasal sinuses. If the scans are positive (opacification, mucosal thickening, air-fluid level), aspiration is performed after meticulous nasal disinfection. Infection is confirmed if a pathogen is identified along with neutrophils. Nosocomial sinusitis is usually caused by gram-negative bacilli or is polymicrobial. Pseudomonas aeruginosa, the most common causative organism, represents 15.9% of isolates. The most common gram-positive isolate is Staphylococcus aureus (10.6%); fungi represent 8.5% of isolates. Infection is treated with aspiration and systemic antibiotics. Treatment failures are common; drainage with indwelling catheters is sometimes necessary.

TI: Nosocomial outbreak of multi-resistant Acinetobacter baumannii on a surgical ward: epidemiology and risk factors for acquisition.

AU: Koeleman-JG; Parlevliet-GA; Dijkshoorn-L; Savelkoul-PH; Vandenbroucke-Grauls-CM

SO: J-Hosp-Infect. 1997 Oct; 37(2): 113-23

AB: Between December 1994 and April 1995, a nosocomial outbreak caused by a multi-resistant Acinetobacter baumannii, occurred on a surgical ward in our hospital. The organism was isolated from 13 patients, eight of whom were infected whereas the others were colonized. Twelve isolates were compared by cell envelope protein electrophoretic profiles and AFLP, a recently described DNA fingerprinting method. Both methods indicated that this outbreak was caused by spread of a single strain, which was identified as A. baumannii by amplified ribosomal DNA fingerprinting (ARDRA). A case-control comparison was performed to identify risk factors associated with nosocomial acquisition of A. baumannii. Risk factors for cross-colonization were length of stay, surgery, wounds and treatment with broad-spectrum antibiotics. Cross- infection with A. baumannii among patients occurred despite implementation of stringent infection control measures. The outbreak was controlled after temporary closure of the surgical ward for disinfection purposes. Patients admitted on a general surgical ward colonized or infected with multi-resistant A. baumannii strains should alert the hospital infection control team, and prompt implementation of strict infection prevention measures to prevent further spread is advised.

TI: [Risk factors and length of stay attributable to hospital infections of the urinary tract in general surgery patients]

AU: Medina-M; Martinez-Gallego-G; Sillero-Arenas-M; Delgado-Rodriguez- M

SO: Enferm-Infecc-Microbiol-Clin. 1997 Jun-Jul; 15(6): 310-4

AB: BACKGROUND: Urinary tract infection (UTI) is the second frequent site of infection in surgical patients; nevertheless, its study has been frequently neglected. The main objective of this report is the analysis of risk factors for ITU in general surgery. METHODS: A prospective study on 1,483 patients admitted at a service of general surgery for a 20-month study period has been carried out. The criteria used for diagnosing nosocomial were those of the CDC. Crude and adjusted for by logistic regression relative risks and its 95% confidence interval were estimated. To assess the length of stay attributable to UTI, infected patients were 1:1 matched with non-infected patients for surgical procedure, ASA score, age (+/- 10 years), emergency surgery, pre-operative stay, and urinary catheter. RESULTS: 33 patients (2.2%) developed UTI. In crude analysis, UTI risk was significantly associated with urethral catheter (and its duration), advanced age, severity of illness (McCabe-Jackson scale, ASA score, number of diagnoses), type of surgical wound, intrinsic risk of infection (measured by the SENIC and NNIS indices). Stepwise logistic regression analysis selected three independent predictors: urethral catheter, age and pre-operative stay. All urinary drainages were open. UTI prolonged hospital stay 4.7 days (95% Cl 3.4-6.2). The use of closed drain-age systems would eliminate 6 UTIs. Assuming a cost per day of hospital stay of $250 the use of closed systems would save $7,000 (IC 95%, 5300-9300). CONCLUSION: The use of closed systems for urethral catheters is cost-saving.

TI: Nosocomial infections in pediatric patients with burns.

AU: Weber-JM; Sheridan-RL; Pasternack-MS; Tompkins-RG

SO: Am-J-Infect-Control. 1997 Jun; 25(3): 195-201

AB: BACKGROUND: Nosocomial infections (NI) are believed to occur more commonly in patients with burns than in patients undergoing surgery, but benchmark rates have not been well described, and widely accepted definitions of NI in patients with burns are not available. We present a clinically useful set of definitions for NI for the pediatric burn population and provide benchmark infection rates for NI at selected sites. METHODS: Centers for Disease Control and Prevention definitions were modified to more accurately describe nosocomial burn infection and secondary bloodstream infections (BSI) in the burn population. A surveillance system was developed and included calculation of NI rates by 1000 patient or device days, stratified into one of three risk groups (< 30% burn injury, 30% to 60% burn injury, and > 60% burn injury). All patients with acute burns admitted from January 1990 to December 1991 were included, and NI rates were calculated for burn infection, primary and secondary BSI, ventilator-related pneumonia and urinary catheter-related urinary tract infection (UTI). RESULTS: Overall 12.5% of patients with central venous catheters had development of primary BSI for a rate of 4.9/1000 central venous catheter-days. Incidence of secondary BSI was 5.8% of patients for a rate of 5.3/1000 patient-days. Incidence of burn infection was 10.1% of patients for a rate of 5.6/1000 patient-days. Incidence of ventilator-related pneumonia was 17.5% of patients for a rate of 11.4/1000 ventilator-days. Incidence of urinary catheter-related UTI was 17.9% of patients, for a rate of 13.2/1000 urinary catheter-days. When rates were stratified by risk groups, incidence increased with increasing burn size for secondary BSI (p < or = 0.0001) and urinary catheter-related UTI (p = 0.08), although rates based on number of patient-days or device-days more accurately reflected risk of infection over time. CONCLUSIONS: Infection remains a cause of significant morbidity and death for patients with burns. The definitions and benchmark rates reported here may be useful in evaluation of NI surveillance strategies and calculation of infection rates, which could then be used to evaluate current treatment modalities and improve outcomes for the burn population.

TI: Cefotaxime in the treatment of prophylaxis of surgical infections.

AU: Wittmann-DH; Jones-RN; Malledant-J; Privitera-G

SO: J-Chemother. 1997 May; 9 Suppl 2: 19-33

AB: Cefotaxime has retained its broad-spectrum activity against the key pathogens in surgical infection, despite 15 years of widespread use. It has good activity against a wide range of Gram-positive and Gram-negative aerobes and most anaerobes, except Bacteroides fragilis but, combined with metronidazole, it offers clinically complete coverage of B. fragilis and Escherichia coli, the two most important species involved in intra-abdominal infections. For mixed infections involving B. fragilis, 500 mg metronidazole 12-hourly should be added to the cefotaxime regimen. Cefotaxime therapy is simple, generally inexpensive and has a relatively broad spectrum of activity compared to many other antimicrobials used for postoperative nosocomial pneumonia. Treatment with cefotaxime at 1 g or 2 g can be 12-hourly. Surgical prophylaxis with single-dose cefotaxime (1 g or 2 g) is as effective as with many other agents, with no documented selection of resistance. Clinical experience gained worldwide strongly supports the use of cefotaxime for the treatment of prophylaxis and surgical infections.

TI: The challenge of postoperative infections: does the surgeon make a difference?

AU: Holzheimer-RG; Haupt-W; Thiede-A; Schwarzkopf-A

SO: Infect-Control-Hosp-Epidemiol. 1997 Jun; 18(6): 449-56

AB: Postoperative infections remain a challenge in many surgical procedures despite improved surgical technique and powerful antibiotics. The number of sepsis cases has tripled from 1979 to 1992 due to increased invasive procedures in older and immune-suppressed patients. Increasingly, in recent years, tbreaks of resistant pathogens have been published, provoking the question of how postoperative infections and resistant pathogens should be dealt with. Wound classification and risk stratification were developed to identify patients at risk for postoperative infection. However, other important intrinsic factors of the patient were not included, and further attempts have been made to increase sensitivity and specificity (e.g., Study on the Efficacy of Nosocomial Infection Control project, National Nosocomial Infection Surveillance System score); the American Society of Anesthesiologists preoperative assessment score and the operation duration for specific procedures were introduced into the system as risk stratifiers. Advances in immunology have identified new ways in which the surgeon can moderate the immune response (e.g., hemorrhage and blood transfusion-induced immune suppression). The increased rate of resistance in enterococci and staphylococci has refocused attention on infection control in surgery. However, there are recent reports from both sides of the Atlantic indicating that guidelines for infection control and antibiotic policy have not become reflected in standard procedures in many hospitals. New antibiotics may be developed, but resistance soon may follow. Sound techniques in surgery, with careful infection control and antibiotic policies, may be the only strategy to prevent further increases in resistance of pathogens in postoperative infections.

AU: Wallace WC, Cinat M, Gornick WB, Lekawa ME, Wilson SE

AD: Division of Trauma Surgery and Critical Care, University of California, Irvine, Medical Center, Orange 92868, USA.

TI: Nosocomial infections in the surgical intensive care unit: a difference between trauma and surgical patients.

SO: Am Surg. 1999 Oct. 65(10). P 987-90.

MH: Cross Infection:*EP. Intensive Care Units:*SN. Bacteremia:EP. California:EP. Incidence. Pneumonia:EP. Prospective Studies. Surgical Wound Infection:EP. Urinary Tract Infections:EP.

AB: In 1970, the Centers for Disease Control and Prevention (CDC) established the National Nosocomial Infection Surveillance System to assist institutions with infection surveillance, data collection, and processing. This facilitates interinstitutional comparison for nosocomial infection rates. Nosocomial infection rates in the surgical intensive care unit have been shown to be different from the medical intensive care unit. Whether there exists a difference in infection rates between trauma and surgical patients in the intensive care unit has not been established. Our objective was to determine whether there is a difference in rates of nosocomial infections between trauma and surgical patients in the surgical intensive care unit. From January 1995 through December 1997, we reviewed 3715 admissions to the surgical intensive care unit and separated them into trauma (1272) or surgical (2443) cases. We documented all nosocomial pneumonias, urinary tract infections, bloodstream infections, and surgical site infections. From these data we determined infection rates per 100 admissions. We also identified all device-related nosocomial infections and calculated infection rate by current CDC standards using number of device infections divided by number of device-days times 1000. We found that the overall trauma patient infection rate was 11.64 per cent compared with 6.43 per cent for surgical patients (P<.001). Using conventional infection rate criteria, trauma patients had higher frequency in the rate of ventilator-associated pneumonia (6.13% vs. 2.50%; P<0.001), urinary tract infection (2.36 versus 1.76; P<0.2), and bloodstream infection (2.52% versus 1.27%; P<0.01). However, when using the CDC guidelines, which correct for the number of device-days for infections, only the difference in rate of pneumonia between the two groups reached statistical significance (23.9 rate for trauma patients vs. 16.7 for the surgery group; P<0.005). We conclude that trauma patients are at higher risk for nosocomial infections than routine surgical patients. Because of this difference, centers should collect and report data separately for trauma and surgical patients in the intensive care unit. Specific attention should be focused on the causes and prevention of increased rates of nosocomial pneumonia in trauma patients.

** Full text is available **

AU: Wallace WC, Cinat M, Gornick WB, Lekawa ME, Wilson SE

AD: Division of Trauma Surgery and Critical Care, University of California, Irvine, Medical Center, Orange 92868, USA.

TI: Nosocomial infections in the surgical intensive care unit: a difference between trauma and surgical patients.

SO: Am Surg. 1999 Oct. 65(10). P 987-90.

MH: Cross Infection:*EP. Intensive Care Units:*SN. Bacteremia:EP. California:EP. Incidence. Pneumonia:EP. Prospective Studies. Surgical Wound Infection:EP. Urinary Tract Infections:EP.

** Full text is available **

Palliative Care / Палиативни грижи

AU: Kaasa S, Loge JH, Knobel H, Jordhoy MS, Brenne E

AD: Unit for Applied Clinical Research, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim.

TI: Fatigue. Measures and relation to pain.

SO: Acta Anaesthesiol Scand. 1999 Oct. 43(9). P 939-47.

MH: Fatigue:*ET/PX. Pain:*CO/PX. Adult. Aged. Aged, 80 and over. Bone Neoplasms:SC. Chronic Disease. Cohort Studies.Hodgkin Disease:DT. Middle Age. Neoplasms:CO. Pain Measurement. Palliative Care. Quality of Life:PX. Questionnaires.

AB: Fatigue describes reduced capacity to sustain force or power output, reduced capacity to perform multiple tasks over time and simply a subjective experience of feeling exhausted, tired, weak or having lack of energy. Pain and fatigue have several components in common, such as being subjective, prevalent in most patients with cancer and caused by multiple factors of both a physical and psychological nature. In order to explore the relationship between fatigue and pain, data from five studies were used: two random samples from the Norwegian population (n=2323 and n=1965), Hodgkin’s disease survivors (n=459), palliative care patients (n=434) and patients with bone metastases (n=94). All patients had completed one or more of the following instruments: EORTC QLQ- C30, SF-36 and/or Fatigue Questionnaire. The level of fatigue was much higher in the two palliative care populations (54.4 and 63.2) as compared to the normal population samples (25.0). Patients with bone metastases had significantly more pain (72. 0) than the patients in the palliative care trial (47.4) and norms (20.5). In the two palliative care and bone metastases populations fatigue was almost unchanged over time, while pain was reduced. In the palliative care population a high level of fatigue (80.3) and pain (57.8) was reported 0-1 month before death. The relationship between pain, fatigue and the health- related quality of life domains should be explored in more detail, especially in follow-up studies in order to assess possible changes over time. In addition, the validity of the existing instruments measuring fatigue should be investigated for use in patients with advanced disease and short life expectancy.

AU: Lefebvre-Chapiro S, Sebag-Lanoee R

AD: Service de gerontologie et de soins palliatifs, Hospital Paul-Brousse, Villejuif.

TI: [Palliative care of the aged]

SO: Rev Prat. 1999 May 15. 49(10). P 1077-80.

MH: Aged:*. Palliative Care:*/PX. Alzheimer Disease:PP/TH. Analgesics:TU. Caregivers. Decubitus Ulcer:TH. Engraving and Engravings. Family. Morphine:TU. Neoplasms:PP/TH. Oral Hygiene. Pain:ET/TH. Quality of Health Care.

AB: Palliative care is no longer limited to patients with terminal cancer but now includes other diseases at terminal stage such as advanced Alzheimer disease. Accompanying the elderly at the end of life involves medical, psychological and social approaches. The expression of symptoms, and especially that of pain, can be atypical. Medical prescription should take into account both the change in drug metabolism and the more frequent occurrence of side effects in the elderly. Accompanying the patient at the end of life is an increasing part of care in geriatric institutions. Indispensable factors today are adapted personnel, training, specific support and social actualization.

AU: Juarez G, Ferrell B, Borneman T

AD: City of Hope National Medical Center, Department of Nursing Research and Education, Duarte, California 91010, USA.

TI: Cultural considerations in education for cancer pain management.

SO: J Cancer Educ. 1999 Fall. 14(3). P 168-73.

MH: Cultural Diversity:*. Ethnic Groups:*/PX. Neoplasms:*EH/PX. Pain:EH/PX/*TH. Palliative Care:*. Patient Education:*. Adult. Aged. Aged, 80 and over. Blacks:PX. Curriculum. Hispanic Americans:PX. Home Health Aides:ED. Los Angeles. Middle Age. Pain Measurement. Quality of Life. Terminal Care:PX. Whites: PX.

AB: BACKGROUND: Ethnicity is an important factor not only in the incidence of cancer but also in relation to symptom management. Inadequate pain management at home has been demonstrated to result in associated physical symptoms as well as great distress to patients and family. METHODS: The study purpose was to evaluate a structure program to educate patients about cancer pain management. The City of Hope quality-of- life (QOL) tool was used to measure patient outcomes in the QOL domains of physical, psychological, social, and spiritual well-being. The Patient Pain Questionnaire was used to assess knowledge and beliefs about pain. RESULTS: A total of 369 patients were enrolled in the study. The three largest groups, Caucasians, Hispanics, and African Americans, were compared. There were several significant differences between groups; overall; Hispanics had the worst pain and QOL outcomes. CONCLU-SIONS: The findings demonstrate significant differences among the three ethnic groups, which indicate a continued need for cultural considerations in patient education.

AU: Briner V

AD: Medizinische Klinik, Kantonsspital Luzern.

TI: [Interdisciplinary discussion about euthanasia—viewpoint of the clinical physicians]

SO: Schweiz Rundsch Med Prax. 1999 Jul 22. 88(29-30). P 1229-34.

MH: Attitude to Death:*. Euthanasia:*TD. Medical Staff, Hospital:* PX. Engraving and Engravings. Palliative Care:TD. Patient Care Team:TD.

AB: In western cities more than 80% of deaths occur in the hospital. Thus, we should be familiar with the professional care for dying patients. However, reports of euthanasia in the Netherlands and interviews of patients in other countries demonstrate that medical care for patients with end stage diseases frequently is insufficient. The need for palliative care, which encloses medical, psychological, social and spiritual aspects of the dying becomes apparent. The physical symptoms (e.g. pain) are only one aspect of the suffering of the terminally ill. Following the WHO guidelines for use of analgesic drugs pain control is achieved in the majority of patients. Palliative care may individually tailor the treatment and care to achieve symptom control. Legalization of euthanasia will diminish the interest in practicing palliative care and may also limit the enthusiasm in research in this field as seen in the Netherlands. Data analysis report significant increase of physician-assisted suicide and euthanasia in the Netherlands within five years time from 1990 to 1995 (total: 3.7% to 4.7%, euthanasia: 1.7% to 2.4%). In addition, each year about 1000 patients were not competent at the time euthanasia was performed (euthanasia without request)! Furthermore, a patients illness did not have to be in end stage when he required euthanasia. This information should rise concern about future developments! The public enthusiasm for legalization of euthanasia in Switzerland may reflect the fear of dying and the belief that physicians and other medical professionals are not equipped to adequately care for the dying. Indeed, professional competence of palliative medicine to treat the symptoms of terminally ill patients particularly with cancer has frequently been insufficient. The majority of Swiss dying with assisted suicide (Switzerland belongs to the few countries where assisted suicide is not illegal) in 1996 and more than 80% in the Netherlands dying by euthanasia had cancer. For the terminally ill euthanasia and assisted suicide may seem the only solution. Enhancing education in palliative medicine is a necessary first step to improve the care for the dying patients.

AU: Maire F, Borowski B, Collangettes D, Farsi F, Guichard M, Gourmet R, Kreher P

AD: Centre Alexis-Vautrin, Nancy.

TI: [Standards, Options and Recommendations (SOR) for good practices in dentistry for head and neck cancer patients]

SO: Bull Cancer. 1999 Jul-Aug. 86(7-8). P 640-65.

MH: Dental Care for Chronically Ill:*ST. Head and Neck Neoplasms:* TH. Adult. Antineoplastic Agents:AE. Child. Engraving and Engravings. Mandible:SU. Oral Hygiene:ST.Palliative Care.Postoperative Com-plications:PC/TH. Radiation Injuries:PC/TH. Radiotherapy:AE.

AB: CONTEXT: The Standards, Options and Recommendations (SOR), initiated in 1993, is a collaborative project between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcomes for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary experts group, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines for dentistry and oral hygiene in head and neck cancer patients. METHODS: Data have been identified by literature search using Medline (up to January 1999) and personal reference lists. The main end points considered were risk factors for treatment related late effects, safety and quality of life, efficacy of dental preventative measures and treatment. Once the guidelines were defined, the document was submitted to reviewers for peer review and to the medical committees of the 20 French Cancer Centres for review and agreement. RESULTS: The key recommendations are: 1) before receiving radiotherapy, surgery and chemotherapy for head and neck cancer, patients must benefit from a multidisciplinary approach including dental evaluation; 2) the patients must be informed of precautions and educated about oral hygiene; 3) after radiotherapy, the most important dental late effect to prevent is radionecrosis, in accordance with the oral and dental state, the dentist may propose conservation or extraction of teeth, fluoridation and regular follow-up; 4) during chemotherapy, the principal complications are mucositis, haemorrhage and infection risk; 5) after surgery, the dentist may propose prosthetic measures with the aim functional, aesthetic and psychological benefit; 6) in the particular case of children, treatment and prevention are the same as for adults but the follow-up is specific because of the dental development.

AU: Powazki RD, Palcisco C, Richardson M, Stagno SJ

AD: Department of Social Work, The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Foundation, OH 44195, USA.

TI: Psychosocial care in advanced cancer.

SO: Semin Oncol. 2000 Feb. 27(1). P 101-8.

MH: Neoplasms:*PX/*TH. Palliative Care:*. Social Support:*.

AB: In palliative care, the focus is management of major symptoms and complications, and psychosocial support of the patient and family. Approaching the end of life, the patient’s needs move beyond physical care to include the psychological, social, and spiritual dimensions. The main psychosocial interventions are counseling, education, and practical services directed at the needs identified by the multidimensional/multidisciplinary assessments. We will present the roles of the various team members and methods of psychosocial assessment.

AU: Komurcu S, Nelson KA, Walsh D, Donnelly SM, Homsi J, Abdullah O

AD: Harry R. Horvitz Center for Palliative Medicine and the Taussig Cancer Center, The Cleveland Clinic Foundation, OH 44195, USA.

TI: Common symptoms in advanced cancer.

SO: Semin Oncol. 2000 Feb. 27(1). P 24-33.

MH: Neoplasms:CO/*PP/*TH. Palliative Care:*. Disease Progression. Gastrointestinal Diseases:ET/TH. Mental Disorders:ET/TH. Respiratory Tract Diseases:ET/TH.

AB: The relief of physical and psychological symptoms is an essential part of palliative care. Advanced cancer is an acute process; because the clinical picture changes rapidly, symptoms must be reassessed regularly, and a careful history is essential. Defining the relationship of the symptoms to the disease can defuse fear and encourage a sense of control in patients and their families. We review the pathophysiology, causes, prevalence, consequence, and management of common symptoms in advanced cancer.

AU: Klee MC, King MT, Machin D, Hansen HH

AD: Department of Oncology, Finsencenter, Rigshospitalet, Copenhagen, Denmark. kleeo@dadlnet.dk

TI: A clinical model for quality of life assessment in cancer patients receiving chemotherapy.

SO: Ann Oncol. 2000 Jan. 11(1). P 23-30.

MH: Antineoplastic Agents:AE/*TU. Neoplasm Metastasis:*PP. Neoplasms:DT/*PP/*PX. Quality of Life:*. Questionnaires:*.Models, Theoretical. Palliative Care. Self Assessment (Psychology). Treatment Outcome.

AB: BACKGROUND:The pattern of symptoms experienced by cancer patients during chemotherapy is very complex. Consequently, quality of life (QOL) assessment has to be carefully planned to capture clinically relevant changes. PATIENTS AND METHODS: A clinical model of changes in symptoms experienced by symptomatic metastatic patients during several courses of chemotherapy has been developed. The model differentiates cancer-related symptoms, acute side-effects, chronic side- effects and symptoms not related to cancer. The model was used to predict changes in each of these four symptom groups. Three time points were selected (post-cycle 2, pre-cycle 3, post- cycle 5) and an appropriate window around each time point was set. The model predictions were tested empirically with 56 patients with advanced ovarian cancer who completed the EORTC QLQ-C30 plus disease specific items during a six-cycle course of chemotherapy. RESULTS: The changes observed in the sample were in accordance with the changes predicted by the clinical model. Results from patients who did not complete the questionnaire within the specified time windows tended to dilute the findings from the group who did. CONCLUSIONS: A clinical model is useful in the planning of QOL assessments in order to capture clinically relevant effects. Such models also facilitate the interpretation of QOL studies, particularly when cyclic short-term effects and chronic side-effects are overlaid on disease symptoms, as is the case with chemotherapy for cancer.

AU: Mercadante S, Fulfaro F, Casuccio A, Barresi L

AD: Department of Anesthesia and Intensive Care, Buccheri La Ferla Fatebenefratelli Hospital, Italy.

TI: Investigation of an opioid response categorization in advanced cancer patients.

SO: J Pain Symptom Manage. 1999 Nov. 18(5). P 347-52.

MH: Morphine:AD/*TU. Neoplasms:*DT/PP. Aged. Analgesics, Opioid: AD/

AB: The aim of this study was to investigate a possible distinction in three categories of opioid response and to identify possible factors associated with a poor response. A prospective survey was carried out in 105 consecutive patients requiring morphine for at least 4 weeks before death. Mean pain intensity, opioid doses and symptom intensity at weekly intervals, pain syndromes, and the presence of psychological distress were assessed. Opioid escalation index (OEI%) was calculated from the parameters recorded. Three categories were considered, including (1) patients with slow increments of opioid dose and a mean analgesic 10-cm visual analogue scale ( VAS) less than 4 (responders), (2) patients with an OEI% more than 5 but a mean VAS less than 4 (partial responders), and ( 3) patients with a mean VAS more than 4 (poor responders). Treating physicians were asked to make a judgment on the pain treatment difficulties on a numerical scale (0-10). Significant differences in opioid starting dose (OSD), opioid dose at—4 weeks, nausea and vomiting at—1 week, opioid maximum doses, mean VAS, and OEI were found in the three categories of response. Significant correlations with the physician judgment were found for opioid maximum dose, mean VAS, VAS at the different time intervals, the doses used at the different intervals, OEI, and confusion. Neuropathic pain was significantly associated with a judgment of poor pain outcome. The correlation between the physician judgment and the categories of opioid response was highly significant. Seven of the 12 patients in the third category (poor response) were considered as having a relevant psychological distress. The categorization of the opioid response used in this study could be used in clinical research and as an audit tool, and could be tested in other settings to compare different treatments.RN: 0 - Analgesics, Opioid; 57-27-2 - Morphine

Suicide: Patterns and Prevention / Самоубийства и превенция

TI: A study of elderly suicides in Hong Kong.

AU: Chi-I; Yip-PS; Yu-GK; Halliday-P

SO: Crisis. 1998; 19(1): 35-46

AB: Hong Kong has one of the highest rates of suicide among the elderly in the world. Most of the existing suicide prevention programs have had very little effect on the elderly, who rarely utilize these programs. This study aims to help in understanding the problem, so that effective prevention can be provided to this high-risk group of suicidal people. Specifically, the study (1) describes the characteristics of the suicidal elderly, (2) investigates the reason(s) why the elderly are in distress and become suicidal, and (3) formulates a policy and service model to reach the elderly high-risk group. This research project involves secondary data analysis. Police records on elderly suicide cases in 1992 were scrutinized to find out the major reason(s) for fatal death in the elderly. Our study points out those districts that are more crowded and have fewer medical and social facilities tended to have higher suicide rates. Most of the deaths occurred at home or nearby, and the suicidal elderly were alone before their death. The majority of elderly suicide victims suffered from chronic diseases. Very few of them, however, were totally dependent: About 40% of the cases had consulted medical practitioners, and 27% had consulted psychiatrists within one month before their deaths. Close to 70% of the cases had indicated to family members or other their suicidal thoughts, and many of them had revealed numerous suicidal indications. Both policy and practice issues are discussed in light of the findings.

TI: [Prevention of suicide among young people—recent experiences from the armed forces]

AU: Mehlum-L

SO: Tidsskr-Nor-Laegeforen. 1998 Apr 30; 118(11): 1724-6

AB: Each year about 70% of all 19-year old males are enlisted to the Norwegian Armed Forces. The rapid rise in the number of suicides among young people will therefore inevitably be reflected among conscripts. Studies of the development of a specific suicide prevention programme which includes educational, leadership and welfare elements, as well as efforts initiated through the military health care service. In addition, an emergency telephone service is available 24 hours a day. This suicide prevention programme, which has its origins in the military chain of command rather than the medical service, has so far been very well received and implemented throughout the Armed Forces.

TI: A solution to the problem of jail suicide.

AU: Cox-JF; Morschauser-PC

SO: Crisis. 1997; 18(4): 178-84

AB: Suicide in local jail facilities can be reduced through interagency cooperation and the implementation of core services. In 1985, the State of New York implemented a comprehensive suicide prevention program within its upstate local jail facilities. The program utilized key coordintion strategies and risk-management service components. It addressed not only the immediate needs of inmates with high-risk profiles, but also focused on the impact of the stressful jail experience on this already vulnerable population. Despite a nearly 100% increase in the jail population, there has been more than a 150% decrease in jail suicides since program implementation.

TI: From chaos to calm: one jail system’s struggle with suicide prevention.

AU: Hayes-LM

SO: Behav-Sci-Law. 1997 Autumn; 15(4): 399-413

AB: This article profiles the suicide prevention practices at a large metropolitan jail, a facility that experienced nine inmate suicides in a recent 24-month period. The suicide rate in this facility was found to far exceed the rate for jails of comparable size as well as the national rate of jail suicides. The nine suicides are summarized and common features (including the issue of protective custody) of the deaths and systemic jail deficiencies are discussed. The process by which the jail system developed a suicide prevention program based upon the principles of staff training, identification/screening, communication, levels of supervision, housing, and intervention is offered.

TI: Social and cultural patterns of suicide in young people in rural Australia.

AU: Baume-PJ; Clinton-ME

SO: Aust-J-Rural-Health. 1997 Aug; 5(3): 115-20

AB: The purpose of this paper is to describe patterns of suicide in

young people in rural communities. Australian Institute for Suicide Research and Prevention and Australian Bureau of Statistics data are used to discuss regional and gender differences in suicide rates, with particular attention to completed suicides in young people. The regional distribution completed suicide in young people and gender differences in suicide rates are identified. Trends in the methods of suicide chosen by young people are also described. Patterns of male self-destructive behaviour are emphasised. The paper, as a whole, draws attention to the complex factors that influence deaths by suicide in young people. The factors implicated are associated mainly with suicide in young males, but much of the literature speculates on rather than demonstrates their influence. As the competing explanations have not been systematically evaluated, further research is required to establish the causal processes involved and to provide a firmer foundation for suicide prevention programs and services for those who live in suicide’s aftermath.

TI: Depression and suicide in young children.

AU: Workman-CG; Prior-M

SO: Issues-Compr-Pediatr-Nurs. 1997 Apr-Jun; 20(2): 125-32

AB: Despite the dramatic increase of depression and suicidal behavior in children, research within this field is limited. Suicide is the 10th leading cause of death in children aged 1 through 14 years. For each child who completes the act of suicide, there are at least 50 more who attempt it. It is difficult to collect statistics on suicide in children owing to the lack of standard criteria for determining suicide in this age group and the myths that surround childhood suicide deaths. Children of all ages, including infants, can xperience depression, but it will be manifested differently across each age group, especially from the infant to the school-aged child. Factors that identify children at risk for suicide include family history, loss of a loved one before the age of 12, violence, decreased family ties, and increased family pressures. Prevention strategies need to be accessible to the child both at home and in school. A variety of community-based suicide prevention programs are available for children and adults to assist children in overcoming suicidal feelings.

TI: Telephone hotline assessment and counselling of suicidal military service veterans in the USA.

AU: Porter-LS; Astacio-M; Sobong-LC

SO: J-Adv-Nurs. 1997 Oct; 26(4): 716-22

AB: Studies show that suicide occurs more frequently among people who are elderly, male, single, divorced or widowed, alienated, and among those with a life-threatening illness. Military service veterans are not spared these conditions; in some respect, they represent the ‘down and out’, the lonely and, increasingly, the older isolated people. This correlational descriptive study sought to identify the characteristic profile of telephone hotline users among veterans, their triggering crisis events, and whether the methods commonly used in suicide attempts relate to certain types of crisis. The random sample consisted of 271 veterans of the US military service, ranging in age from 20 to 79 years. Data were collected from nursing notes documented in the hotline suicide telephone call assessment records. The findings portray a sociodemographic profile of military veterans at risk of suicide attempts. Loneliness, alcoholism and unemployment topped the list of triggering events. The most common method used was drug overdose; shooting was a close second. These findings could serve as a base for development of suicide-prevention-focused programmes and optimal use of telephone hotlines for assessment and timely intervention of persons in great crisis.

TI: Suicide ideation among recent immigrants: an epidemiological study.

AU: Ponizovsky-A; Safro-S; Ginath-Y; Ritsner-M

SO: Isr-J-Psychiatry-Relat-Sci. 1997; 34(2): 139-48

AB: This paper reports preliminary results of an epidemiological survey of suicide ideation among recent adult immigrants from the former Soviet Union to Israel. The study presents one-month prevalence rates of suicide ideation, and the relationship of suicide ideation with demographics, self-rated psychological distress, depression, emotional isolation and social support. Results show that the one-month prevalence rate of suicide ideation in the population is 16.9%. Suicide ideation was most frequent among socially and emotionally isolated immigrants with lower social support. The strongest predictor of suicide ideation for both sexes was level of psychological distress, whereas the severity of depression predicted suicide ideation only in females. The findings can be used as a point of departure for the development of suicide prevention programs

AU: Jacobsson L, Renberg ES

AD: Department of Clinical Science, Umea University, Sweden.

TI: On suicide and suicide prevention as a public health issue.

SO: Med Arh. 1999. 53(3). P 175-7.

MH: Suicide:PC/*SN. Adolescence. Adult. Europe:EP.

AB: Suicide is becoming one of the major causes of death especially amongst men. In Europe suicide is the second most common cause of death in the ages of 15-44 years. For women in the same age group suicide is the fourth most common cause of death. Suicide causes a lot of suffering not only in the victim but also in persons close to him. As the causative factors are complex, and suicide also costs the community a lot of money suicide and self destructive behavior must be considered an important public health issue. A couple of models which are helpful when trying to develop treatment and preventive strategies for suicided persons are presented. The basic principles for contemporary suicide prevention programmesare also described.

TI: Suicide prevention among active duty Air Force personnel-United States, 1990-1999.

SO: MMWR Morb Mortal Wkly Rep. 1999 Nov 26. 48(46). P 1053-7.

MH: Military Personnel:*. Suicide:*PC. United States.

AB: During 1990-1994, suicide accounted for 23% of all deaths among active duty U.S. Air Force (USAF) personnel and was the second leading cause of death (after unintentional injuries) ( Table 1). During those years, the annual suicide rate among active duty USAF personnel increased significantly (p<0.01)

from 10.0 to 16.4 suicides per 100,000 members (Figure 1). In 1995, senior USAF leaders initiated prevention programs in several commands because of the increasing suicide rate. In May 1996, an in-depth study by a team of medical and nonmedical civilian and military experts was initiated to produce a comprehensive, communitywide prevention strategy that viewed suicide not only as a medical but a USAF problem, thus addressing overall social, behavior, and health issues ( 1). The plan was implemented across the entire USAF during 1996-1997. This report describes protective and prevention strategies and summarizes the study findings, which indicate that a substantial decline in the suicide rate was associated with the communitywide program.

** Full text is available **

AU: Jacobsson L, Renberg ES

AD: Department of Clinical Science, Umea University, Sweden.

TI: On suicide and suicide prevention as a public health issue.

SO: Med Arh. 1999. 53(3). P 175-7.

MH: Suicide:PC/*SN. Adolescence. Adult. Europe:EP.

Check Tags: Female..Human..Male.

AU: Perret-Catipovic M

AD: Department of Psychiatry, Geneva University Hospitals,

Switzerland. perret-maja@diogenes.hcuge.ch

TI: Suicide prevention in adolescents and young adults: the Geneva

University Hospitals’ Program.

SO: Crisis. 1999. 20(1). P 36-40.

MH: Suicide:*PC/PX. Adolescence. Adult. Catchment Area (Health). Hospitals, University. Switzerland.

AB: In Switzerland, suicide has become the leading cause of death among the 15- to 24-year-olds. All strategies aiming at preventing suicide are most challenging, but few have demonstrated efficacy. In Geneva, we founded a Unit for SuicidePrevention as a joint venture between the Geneva University Hospitals and a charitable foundation called “Children Action.” Our prevention program duplicates prevention strategies that are known to be effective: tutorials for health professionals and postvention aimed at those who have been exposed to a suicide (or suicide attempt) of a family member or a friend. But it also introduces a new strategy: a hotline for all those in the community who are in contact with a suicidal adolescent. This paper describes our experiences.

AU: Brener ND, Hassan SS, Barrios LC

AD: Division of Adolescent and School Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30341, USA. nad1@cdc.gov

TI: Suicidal ideation among college students in the United States.

SO: J Consult Clin Psychol. 1999 Dec. 67(6). P 1004-8.

MH: Students:*PX. Suicide, Attempted:*PX/*SN. Adolescence. Adult. Questionnaires. United States. Universities.

AB: This study analyzed data from the 1995 National College Health Risk Behavior Survey (NCHRBS) to assess the prevalence of suicidal ideation among college students in the United States and to examine the association between suicidal ideation and substance use in this population. The NCHRBS used a mail questionnaire to assess health-risk behaviors in a nationally representative sample of undergraduate students. During the 12 months preceding the survey, 10% of the students had seriously considered attempting suicide. When controlling for demographic characteristics, the analysis showed that students who had considered suicide were at increased odds of using tobacco, alcohol, and illegal drugs. These results suggest that colleges and universities should establish suicide prevention programs that also address the related problem of substance use.

AU: McArt EW, Shulman DA, Gajary E

AD: Hillside Behavioral Health System, Rochester, NY, USA.

TI: Developing an educational workshop on teen depression and suicide: a proactive community intervention.

SO: Child Welfare. 1999 Nov-Dec. 78(6). P 793-806.

MH: Adolescent Health Services:*OG. Community-Institutional Relations:*. Depression:*PC. Health Education:*OG. Mental Health Services:*OG. Program Development:*MT. Suicide:*PC/SN/TD. Adolescence. Community Networks. Health Personnel:ED.Hotlines:OG. New York:EP. Parents:ED. Pilot Projects. Primary Prevention.Program Evaluation. Referral and Consultation:OG.

AB: Eight years into the YES emergency services collaboration, a comprehensive Youth Emergency Services model has emerged, one that incorporates a proactive approach to clinical and prevention strategies. In addition to direct service provision, these strategies include: (1) workshop training of school and community professionals so that they can identify young persons at highest risk for suicidal thoughts, threats, and attempts; (2) prevention education for both adolescents and parents about suicide, risk factors, and interventions; ( 3) a partnership with the local hotline to facilitate community screening and referral to appropriate crisis services for families and youths; (4) collaboration with a large primary care provider network to streamline the after- hours crisis referral process, using the hotline; and (5) the use of a website to inform individuals about services and resources. It is proposed that this is a contemporary model that can meet the present primary and secondary intervention needs for children, adolescents, and their families.

** Full text is available **

плевенска инициатива: проекти

Програма за реинтеграция на инвалиди с частична загуба на зрение

д-р Маргарита Кирилова

След оформяне на целева група започна работа със слабо зрящи инвалиди. Поради честото спиране на работния процес в ПП “Успех” се проведоха няколко сбирки, на тях бе разяснен принципът на работа на инвалидите в екип и начинът им на взаимопомощ, съвместно с психолог и фелдшерката на здравния пункт и служител от инспекцията по труда, които бяха привлечени доброволно. За работата бяха дискусии. Мястото за провеждане бе отдадено безвъзмездно и трудът на сътрудниците бе доброволен. Работата на слабозрящите бе разделена на две учебни години. След първата учебна година се установи, че слабозрящите инвалиди имат желание и могат да работят на приспособено за тях място заедно или индивидуално с помощта на близки, роднини и приятели. Трудно се преодолява психо-логическият момент за доказване на равнопоставеност при изпълнение на трудовите обязаности. Предстои допълнителна работа с фондация “Рехабилитация на слепи” и Центъра за рехабилитация на слабозрящи в Пловдив.

За първата дискусия ще бъде поканен доц. Владимир Радулов, ръководител на Катедра по педагогика и работа с хора с увредено зрение. В проведените досега мероприятия активно съдействаха ССБ-ООД “Успех” - Плевен и доброволни сътрудници.

Изграждане на студентски център за промоция на здравето

д-р Анжелика Велкова

Цел на проекта е а подготви студенти-лектори за участие в здравно-образователни и здравно-промотивни програми сред децата и подрастващите в гр. Плевен.

До момента са привлечени 22 студенти от ВМИ и Медицински колеж, които са преминали 3 сесии на обучение за методите на здравното възпитание и промоция на здравето. Студентите са разделени в 5 групи по интереси, представляващи 5 важни области на здравното възпитание - нания за тялото и здравето, превенция на тютюнопушенето и наркоманиите, правилно хранене и физическа активност. Участниците в проекта са разработили здравно-образователни материали - лекции, макети на постери, брошури и листовки, които са консултирани със специалисти от съответната област.

Предстои провеждането на еднодневен семинар през ноември, на който студентите ще представят материалите си и ще добият опит за представяне пред аудитория.

Установени са връзки с други проекти от Инициативата и в заключителната фаза студентите могат да участват в проектите на д-р Цв. Виткова, в проектите на Младежкия превантивен център и в проектите за профилактика на хипертонията сред децата чрез диетично хранене и физическа активност.

Рехабилитация на деца, фамилно обременени с хипертония и обезитас

доц. д-р М. Петкова

1. Изработени са анкетни карти на 124 деца с пилотно проучване на ученици от VІ и VІІ клас от училищата “Иван Вазов” и “Цветан Спасов”.

От тях: 21 здрави обременени деца

15 с обезитас

8 с хипертония

За децата с обезитас се изработи личен план за физкултура по избрана рехабилитационна програма.

2. В продължение на три месеца групите са получавали /обременените и тези с обезитас - 36 деца/ диетична храна “Слабин”. Децата с обезитас имат снижение на телесната маса с 2 кг. средно по обективни причини. Рехабилитация не е правена.

Разработване и представяне на здравно-просветни материали на болни от исхемична болест на сърцето - миокарден инфаркт, сърдечна недостатъчност, артериална хипертония

д-р Фредерик Григоров

Създаване на регистър регистрация на болните лица, преживяли миокарден инфаркт.

Проблем: Сърдечно-съдовите заболявания са от водещите социално-значими, икономически и здравни проблеми. Свързани са с неблагоприятна прогноза и влошено качество на живота. Липсата на достатъчно познания и здравна култура за тези заболявания се оказва често важен фактор за неблагоприятните последствия. В редица страни дългогодишни широкомащабни и добре финансово обезпечени програми, насочени към проблемите, свързани със сърдечносъдовите заболявания са показали значителни положителни резултати. У нас поради сложността на проблемите няма много опити за целенасочени действия за подобряване прогнозата и качеството на живота при лица с тези заболявания.

Целта: С подходящо поднесена и достатъчна информация да се повишат необходимите здравни знания - здравна култура и като следствие адекватно отношение към тези сърдечносъдови заболявания и съответно поведение, резултиращи в подобрената прогноза и подобрено качество на живота. Обхващане на болните, преживяли миокарден инфаркт на територията на бившия Плевенски окръг и включването им в регистър, което дава възможност за проследяване и по всяко време да се получи информация за здравословното състояние, да се направи оценка и да се дадат необходимите препоръки или назначат медикаменти.

Обхванати са над 300 болни,преживяли миокарден инфаркт, 163 с прояви на сърдечна недостатъчност и 115 с артериална хипертония. Данните /социален и здравословен статус/ са нанесени на унифицирани, предварително разработени карти и предстои включването им - реализиране на единен регистър. На повечето от тях са представени подходящи здравно-просветни материали, мониторира се здравословното им състояние и оценката им за качеството на живота. В здравно-просветните материали се обръща основно внимание на три неща: представяне на достатъчна по обем информация, подчертава се нуждата от добри отношения с личния лекар или лекаря-специалист, а също и на самоконтрола, раздадени са дневници за самоконтрол и таблици за оценка на здравословното състояние.

Здравно-образователна програма за ограничаване разпространението на наркоманиите сред учащите се в Плевенска област

Д-р Цветелина Виткова

Проведени са 22 дискусии с видеопрожекции с 1350 ученици.

Обучение на 5 ученици - обучители на тема “Профилактика на наркоманиите”.

Проведени са пресконференция и хепънинг по повод 26 юни - Световен ден за борба с наркоманиите. Подготвени и разпростране-

ни са стикери и здравно-образователен материал “Знаем ли за наркотиците”.

Образователна програма за превенция, рехабилитация и лечение на пациенти с ХОББ

д-р Пламен Павлов

В открития за тази цел център е сформиран екип от специалисти.

Завършено е техническото и информационно оборудване на центъра.

Уточнени са алгоритмите на терапевтично поведение при пациенти с ХОББ.

Подбрана е група от 80 пациенти, на които са предоставени медикаменти за модерно лечение.

Получените досега резултати показват намаляване на броя на хоспитализациите при 78% от пациентите и подобряване качеството на живот при повече от 40% от тях.

Предстои имунопрофилактика през м. 10 т.г.

Практически подходи за своевременна диагностика и лечение на пневмонии в Плевенски регион

д-р Павлина Глоговска

Цел: Разработване на подходи, практически приложими за диагностика на най-често срещаните пневмонии в извънболнични условия.

1. Проведени са две работни срещи с ОПЛ.

2. Подготвени са листовки с актуална информация за тези пневмонии.

3. Набират се епидемиологични данни за характеристиката на тези заболявания в Плевенски регион.

4. Изследвани са 90 пациенти, съмнителни за съответните пневмонии с 35 положителни резултата.

Предстои изследване на още 50 пациента през този сезон, обобщаване на резултатите и изготвяне на практически подходи в помощ на ОПЛ.

Подобряване на качеството на извънболничната диагностика на 10 най-често срещани инфекции в гр. Плевен

д-р Радко Велков

Набрани са епидемиологични данни за най-често срещаните инфекции в региона. При 6 типа от тях е изработен съвместно с клиницистите алгоритъм за диагностика. Най-добри резултати са постигнати при гинекологичните случаи - 400 обработени, като 90% от тях са с благоприятно повлияване.

Ограничаване разпространението на ехинококозата в гр. Плевен

д-р Жени Бошнакова

Проведено до момента:

- анкета за информираност на обществеността по проблема;

- преброяване на бездомните кучета в границите на града;

- изработване на филм - промоция по проблема, който ще се излъчи по кабелната телевизия;

- две пресконференции с местните медии;

- една среща със заместник-кмета д-р Матеев;

- родителски срещи в детски заведения.

Предстоят още срещи с представители на обществеността по проблема. Очаква се новата национална програма за борба със зоонозите.

Ще се направи още една сравнителна анкета и още едно сравнително преброяване.

Ранна рехабилитация за деца с увреден слух

Иванка Радева - сурдопедагог

Проведени са срещи със специалисти по ранна рехабилитация и срещи с учителите и родителите на тези деца.

Изготвени методически указания за педиатрите.

Изготвен е професионален видеоматериал.

Открити са 24 нови деца

Работи се с тясно сътрудничество със Съюза на глухите в България.Предстои изграждане на система за контакти с ОПЛ.

Информационни комуникации между ОПЛ, диагностични и консултативни звена

Благовест Бечев

Създава се софтуер, който поддържа електронните записи за пациентите: анамнеза, статус, манипулации, наблюдение, терапия, диспансеризация, медицински справки и отчети, изисквани от ЗОК.

Чрез анкета са уточнени приоритетните области на приложение на софтуера.

Проведен е курс за обучение на ОПЛ по начална компютърна грамотност и използване на специализиран медицински софтуер.

Предстои:

- нов курс;

- внедряване на продукта на четири места;

- разработване на необходимите модули за някои специалисти.

Локална просветна и скринингова програма за рак на млечната жлеза /РМЖ/ сред жените на 30 и повече години от гр. Плевен и региона

д-р Румен Стоянов

Работи екип от 6 хирурзи, 2 рентгенолози и един цитолог.

Двете направления са:

- просветна програма за ролята на самоизследването в ранната диагностика на РМЖ - 2 видеофилма, 2 постера, 5 брошури и др.

- локална скринингова програма.

В профилактичен мамологичен кабинет за три години са извършени 2703 прегледа. При 42 жени е открит РМЖ и са насочени за комплексно лечение. При 1412 е диагностицирана бенигнена патология и те са диспансеризирани със специален фиш.

Образователна програма за студентите от Педагогическия колеж - Плевен по профилактика на сърдечно-съдови заболявания

д-р Ирина Джикова

Проектът е представен пред колежа. Проведени са обучителни лекции, входяща и изходяща анкета. Подготвени и раздадени здравно-образователни материали.

Програма за обучение в принципите на здравословното хранене на деца с наднормено тегло

д-р Мариела Генова

Прицелната група обхваща 22 ученици с наднормено тегло.

Измерени са ръст, тегло, артериално налягане и са изследвани кръвта за серумни липиди.

Проведени са консултации с лекар - диетолог и е съставен диетичен режим, съобразен с особеностите на всяко дете.

Подготвиха се здравно-образователни материали - 2 листовки: “Затлъстяване”, “Здравословно хранене на децата” и един печатен материал “Затлъстяване”.

Краен резултат: 45% от участниците нормализираха теглото си.

Образователна програма за превенция, рехабилитация и лечение на пациенти с ХОББ

д-р Пламен Павлов

В открития за тази цел център е сформиран екип от специалисти.

Завършено е техническото и информационно оборудване на центъра.

Уточнени са алгоритмите на терапевтично поведение при пациенти с ХОББ.

Подбрана е група от 80 пациенти, на които са предоставени медикаменти за модерно лечение.

Предстои имунопрофилактика през м. 10 т.г.

Проспективно регистриране и ранно лечение на болни с мозъчен инсулт от Плевенски регион”

Доц. д-р Марина Попова, лекарски екип от Втора неврологична клиника

От поставените задачи за осъществяване на проекта са частично реализирани следните:

1. Изработена е документация на проучването - 2 броя формуляри (използвани са стандартни образци на СЗО, преведени на български език).

2. В ежедневната работа на Втора неврологична клиника се използват критерии за хоспитализация на инсултно болни (на Здравната администрация на САЩ, приспособени към нашите условия).

3. Изработено е “Ръководство за доболнично поведение и лечение на мозъчен инсулт”, предназначено за ползване от общопрактикуващите и лекарите от ЦСМП. Ръководството е прието на заседание на Консултативния съвет по мозъчно-съдова болест към МЗ с председател проф. д-р Димитър Хаджиев. Получени са два положителни отзива. Предстои да бъде представено в МЗ за одобряване като издание на Министерството.

Съществуват значителни проблеми във връзката с общопрактикуващите лекари и предаване на информацията за прегледаните болни с мозъчен инсулт от екипите на ЦСМП. За осъществяване на проекта и реално създаване на условия за ранно регистриране и лечение на болните с мозъчен инсулт в Плевенски регион са възможни 2 подхода:1. Създаване на предаващо-приемащо устройство в ЦСМП и Втора неврологична клиника, работещо на принципа на факс и модем. Този подход обхваща целия Плевенски регион и има предимството, че ще се предава цялата информация за прегледаните в станциите и по домовете инсултно болни и ще осигури необходимите паспортни данни.2. Създаване на мобилна телефонна връзка за дежурния невролог във Втора неврологична клиника за постоянна връзка с общопракти-куващите лекари.

Значението на този подход е съмнително и ограничено.

Комплексна профилактика при деца в училищна възраст, фамилно обременени за атеросклероза в две училища на гр. Плевен

Д-р Георги Николов

I. Проведени профилактични мероприятия.

1. Лечебна физкултура.

2. Хипокалорийна диета.

3. Третиране на дислипедимиите.

II. Получени резултати.

Изследвани са две групи: деца с фамилна обремененост за атеросклероза – I група (n=48).

II група – клинично здрави лица на същата възраст (n=28).

Преди След

Профилактиката профилактиката

I група

Еластинови пептиди: 96±26 нг/мл 89±21 нг/мл

Колагенови пептиди: 215±46нг/мл 201±40 нг/мл

Еластинови антитела:

IgМ 0.701±0.058 0.693±0.055

IgA 0.152±0.067 0.147±0.042

IgG 0.698±0.088 0.681±0.079

Колагенови антитела:

IgM 0.830±0.089 0.815±0.071

IgA 0.162±0.055 0.157±0.049

IgG 0.573±0.096 0.569±0.079

При контролните здрави лица не се наблюдават промени в изследваните показатели.

Извод: Проведените профилактични мероприятия дават ефект, който обаче е недостатъчно добър на този етап. Необходимо е да се продължат профилактичните мероприятия и да се проведе второ тестуване през м. юни 2001 г. изследваните показатели.

Pleven Initiative Projects

Social reintegration of partially blind people

Dr. Margarita Kirilova

A target group was formed, and several meetings were organized at a factory in Pleven which employs disabled people. At these meetings, the goals of the project were presented by a team (the project coordinator – an ophthalmologist, a psychologist, the person in charge of the factory health center, an officer from the labor inspection service). The main point was to promote teamwork as effective in solving problems of reintegration.

The meetings proved useful to prepare them take the challenges, and be ready to do a job, adapted to their capabilities, on their own or with other members of the group, and with or without the assistance of relatives or friends.

To further build confidence, the project will cooperate with the “Rehabilitation for the Blind Foundation” and with the Center for Rehabilitation for the Blind in Plovdiv. The head of the department of pedagogy for people with impaired vision – Prof. Vladimir Radoulov will also participate in the second stage of the project. The factory in Pleven, social services and volunteers supported the activities carried out so far.

Starting up a students’ center for health promotion

Dr. Angelica Velkova

The aim of the project is to prepare students medical students to participate as tutors in health educational and health promotional programs for children and adolescents in Pleven.

So far, 22 students from the Medical University and the Nursing College have volunteered. Three training sessions were organized, focused on methods of health education and promotion. The students were divided into five groups according to their interest in areas of health education: the human body and health, prevention of smoking and drug use, proper diet and physical activity. They have prepared health educational materials – lectures, poster projects, brochures and leaflets. The materials were consulted with specialists in the respective areas. During a one-day workshop the students will present the materials to their co-eds.

Collaboration has been established with some other Pleven Initiative for Better Health projects. The students will be involved in projects on drug use prevention, in the programs of the Regional Drug Abuse Prevention Center, in the projects on hypertension prevention by proper diet and physical exercise.

Rehabilitation for children with family history of obesity and hypertension

Assoc. Prof. M. Petkova

An inquiry among 124 children aged 13-14 in “Ivan Vazov” and “Tzvetan Spasov” schools in Pleven helped identify 21 healthy children with a family history, 15 – with obesity, and 8 - with hypertension.

For the obese children, individual plans for physical exercise were prepared.

For three months 36 children received diet food “Slabin” provided by the firm that produces it. The obese children lost two kilograms of body mass on the average.

Health education to reduce drug addiction among school children in Pleven region

Dr. Tzvetelina Vitkova

- Twenty-two talks and discussions were organized with 1350 students, and videos were shown during the meetings. Five adolescents were trained to carry out peer education on the problems of drug use prevention. A special sticker was prepared and distributed.

- A press conference and a happening were organized on the World Day of Drug Abuse Prevention – June 26^th. A brochure was prepared with basic information on the effects of drug use.

A program for prevention and rehabilitation and treatment of COPD

Dr. Plamen Pavlov

A team of specialist was built at the center for prevention and rehabilitation and treatment of COPD, and equipment and computers with software were provided, and algorithms of therapeutic approaches have been agreed upon.

A group of 80 patients with COPD has been selected, and they were provided with modern medication.

The results obtained so far show that the number of hospitalization has been decreased in 78% of the patients, and 40% of them report improvement of quality of life.

Immunoprophylaxis is to be provided in October.

Practical approaches for timely diagnosis and treatment of pneumonias in the Pleven region

Dr. Pavlina Glogovska

The aim of the project is to build approaches applicable for diagnosing of most common pneumonias outside the hospital.

Two meetings with general practitioners were organized, and updated information on these pneumonias was distributed. Database on the epidemiology of pneumanias in the Pleven region is currently collected and updated.

So far, 90 patients have been investigated, suspected for the respective type of pneumonias. In 35, the results were positive for atypical pneumonias.

A new group of 50 patients will be tested. Results will be processed and then analyzed. After that practical approaches will be offered to assist general practitioners.

Improvement of diagnosis for 10 most common infections in Pleven

Dr. Radko Velkov

Epidemiological data on the ten most common infections has been collected. For six of these, an algorithm applicable in everyday practice was prepared in collaboration with general practitioners.

The best results from the application of the algorithm have been achieved in a gynecological practice. In 90% of 400 cases, results from diagnosis (and treatment) were favorably affected by the approach.

A health education program to decrease echinococcosis rates in Pleven

Dr. Jeni Boshnakova

An inquiry was carried out to assess the level of knowledge of the ppulation on the problem, and the street dogs on the territory of Pleven were counted. A videofilm was made to raise the awareness on the problem.The video will be shown on the local TVs.

Two pressonferences were organised to present the problem to the local media, and seek collaboration with them. Local government in the face of Dr. Mateev– the Deputy Mayor in charge of health has been acquainted with the program, and collaboration with other organizations is sought.

Talks were organized with parents of kindergarten children aged 3-7.

A new inquiry is to be organized to assess the results from the project activities, and assessment of the dog population. In view of a national program dealing with the problem, we think that the project will find us better prepared to solve the problem..

Early rehabilitation for children with hearing disablement

Mrs. Ivanka Radeva

Twenty-four children were diagnosed with different degree of hearing disablement, and were consulted by a specialist. Meetings were organized with tacheres and parents. Pediatricians were informed about the rehabilitation program of the center. Videofilms were made and shown to parents and teachers.

The center in Pleven works in close collaboration with the Bulgarian Union of People with hearing disablement. In view of the health reform, contacts are to be established with general practitioners.

Exchange of information between GPs, diagnostic and consulting centers

Mr. Blagovest Bechev

Software was designed to collect database on patients of a general practice and information required by the health insurance fund. The software was designed to meet the needs as assessed by GPs.

Computer courses were organized for GPs during which they were traine use the software.

The software will be initially used at four places of work, and software will be adapted to be used at consulting centers.

A local educational and screening program for early detection of breast cancer in Pleven and the region among women over 30

Dr. Roumen Stoyanov

The two main aspects of the program, carried out by a team of six oncosurgeons, two radiologists and a cytologist are education and screening. Education includes poviding information on the role of self-examination, and regular check ups. Two videofilms, two posters and 5 brochures were prepared and distributed. Within the screening program, 2703 women were examined. Of these, 42 were diagnosed with breast cancer and referred for treatment. Those diagnosed with benign pathology (1412) were registerd for follow-up.

An educational program on risk factors for cardiovascular disease among students at the Pleven College for primary school teachers

Dr. Irina Djikova

The project was presented to the students and college authorities. The material on risk factors was included in the curriculum, and the level of knowledge on the problem was assessed at the beginning and end of the course.

Teaching principles of a proper diet to overweight children

Dr. Mariela Geneva

The target group included 22 overweight children. Body mass index, serum lipid levels and arterial blood pressure were checked. A specialist in dietetics consulted the children and individual diet was recommended. Health educationmaterials were prepared and distribited: two leflets on obesity and healthy diet, and one brochure on obesity. By the nd of the program, 45% of the children had reduced their weight to normal.

Health education for patients with ischaemic heart disease, cardiac insufficiency, arterial hypertension and AMI and registering for long-term follow-up

Dr. Frederic Grigorov

Cardiovascular diseases are associated with a number of social, economic and health problems, with poor prognosis and deterioration in life quality. The lack of patient knowledge often proves an important factor contributing to poor prognosis.

Good results have been achieved through the implementation long term, large scale and well-funded educational programs for patients cardiovascular diseases. Unfortunately, in our country there are few attempts to solve the problem of improving the prognosis and the quality of life in such patients.

The aim of the projects is to provide relevant and sufficient information to raise the level of knowledge in these patients. This can lead to changing their attitude and life styles, thus improving the prognosis and quality of life.

Registering AMI patients from the Pleven region for long-term follow-up, on the other hand, is expected to provide enough information allowing for assessment and adequate treatment.

So far, 300 AMI patients, 163 with cardiac insufficiency and 115 with arterial hypertension have been registered for follow-up. Data on social and health status have been entered in files. Patients have been provided with health education materials, their health status and their assessment of life quality are monitored. Materials focus on adequate information, regular visits to the GPs and/or cardiologist, and self control. Patient diaries include criteria for self-control and assessment.

Health education to reduce drug addiction among school children in Pleven region

Dr. Tzvetelina Vitkova

Twenty-two talks and discussions were organized with 1350 students, and videos were shown during the meetings. Five adolescents were trained to carry out peer education on the problems of drug use prevention. A special sticker was prepared distributed.

A press conference and a happening were organized on the World Day of Drug Abuse Prevention - June 26. A brochure was prepared with basic information on effects of drug use.

A program for prevention and rehabilitation and treatment of COPD

Dr. Plamen Pavlov

A team of specialist was built at the center for prevention, rehabilitatiomn and treatment of COPD. Equipment and software were provided, and algorithms of therapeutic approaches were agreed upon.

A group of 80 patients with COPD was selected, and medicines were provided for treatment.

The results so far show that the number of hospiatlizations has decresed in 78% of the patients, and 40% of them report improvement of life quality.

Immunoprophylaxis is planned for.

Prospective registration and early treatment for stroke patients in the Pleven region

Assoc. Prof. Marina Popova

Together with a team of neurologists from the Second Clinic of Neurology at the Univesity Hospital in Pleven, the following was accomplished:

1. Two standardized forms were prepared for registering stroke patients.

2. Routine criteria for hospitalization of stroke paients are applied at the clinic. These criteria are adapted to the exsting practice in Bulgaria.

3. A manual for prehospital standard procedures and treatment wa prepared, designed to the needs of General Practitioners and emergency hospital physicians. The manual was approved by the advisory board on cerebrovascular disease at the Ministry of Health, chared by prof. Dmitar Hadjiev. In the near future the manual will be published by the ministry of Helath.

Problems: There are problems with communications between GPs/ emergency hospital teams and the neurology clinics. Two approaches are can possibly solve the problem of early registration and treatment for stroke patients in the region: 1. Opening a fax-modem line at the clinic and the emergency hospital. Thus the whole region will be covered.2. Establishing a mobile phone line, where the neurologist on duty can consult GPs.

Complex prophylaxis in schoolchildren with a family history of atherosclerosis in two school in Pleven

Dr. Georgi Nickolov

The target group included 48 children with a family history of atherosclerosis (TG), and the control group (CG) of 28 children, matched in age and clinically healthy.

Remedial gymnastics was organized, and low-calorie diet was recommended. Lipidemias were treated.

Results from investigations so far are as follows:

Before intervention After intervention

Elastine peptides 96±26 ng/ml 89±21 ng/ml

Collagen peptides 215±46ng/ml 201±40 ng/ml

Elastin antibodies:

IgМ 0.701±0.058 0.693±0.055

IgA 0.152±0.067 0.147±0.042

IgG 0.698±0.088 0.681±0.079

Collagen antibodies:

IgM 0.830±0.089 0.815±0.071

IgA 0.162±0.055 0.157±0.049

IgG 0.573±0.096 0.569±0.079

With healthy children, no changes were observed.

Conclusion: The prophylactic activities have lead to changes in the values of peptides and antibodies investigated. However, the improvement is not satisfactory at this stage. The remedial gymnastics, low-calorie diet and treatment of lipidemias will continue, and the tests will be repeated in June 2001.