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ОНКОЛОГИЧНАТА ПОМОЩ В УСЛОВИЯТА НА ЗДРАВНАТА РЕФОРМА В БЪЛГАРИЯ - ТЕНДЕНЦИИ, ПЕРСПЕКТИВИ И ПРИОРИТЕТИ / ONCOLOGICAL CARE AND HEALTH REFORM IN BULGARIA: TRENDS, PERSPECTIVES AND PRIORITIES

MEDLINE INFORMATION

- Breast Cancer / Рак на гърдата

- Colorectal Cancer / Колоректален рак

- Suicide: Patterns and Prevention / Самоубийства и превенция

ЗАВЪРШЕНИ ПРОЕКТИ / COMPLETED PROJECTS

ДЕЙСТВАЩИ ПРОЕКТИ  / PROJECTS IN ACTION

 

Новини

 

     През месец март във Великобритания се проведе семинар на Здравна фондация “Драйфус”. Участваха координатори на програмите “Решаване на проблеми за по-добро здраве” и “Комуникации за по-добро здраве” от всички страни, в които се работи по програмите.

     Регионалните координатори д-р Ян Соботка /Европа и Близкия изток/, Д-р Даниел Бекер /Централна и Латинска Америка/, г-жа Он Нинг /Азия/, г-жа Рут Чикаса /Африка/ и г-жа Марша Копланд-Джакс /САЩ/ представиха постигнатото по програмите в отделните страни и регионите.

     По време на работата по групи и пленарните заседания се обсъдиха проблемите и перспективите на програмите.

     Специален гост на семинара беше г-н Джак Драйфус – основател на Здравна фондация Драйфус. На пленарно заседание той представи книгата си “Едно забележително лекарство остава неизползвано”, и разказа за действията, които е предприел за популяризирането на фенитоина като препарат с широк спектър на приложение. Г-н Драйфус  се срещна лично с всички участници в семинара, работили по проекти с фенитоин. От българска страна в тези срещи участва доц. Мария Александрова, а д-р Камен Каменов представи на г-н Драйфус българския превод на специализираната част на книгата.

     Желаещите да се запознаят с тази материал могат да го прочетат в ИНТЕРНЕТ на адрес: http://www.dhf-bg.org/

По време на срещата се обсъдиха и перспективите на програмите в страните и регионите.

 

Предстоящо:

 

     През месец май в Стара Загора ще се проведе семинар “Инициатива за по-добро здраве”. Досега заявка за участие са направили 42 души.

     Семинари за проследяване на работата по проекти ще се проведат в Габрово /12 юни/ и Варна /14 юни/.

     През месец юни се предвиждат и срещи с представители на различни организации за подготовка на семинари в Плевен /август, 2001/ и София /септември/.

     За повече информация по програмите на Здравна фондация  “Драйфус” можете да прочетете на адрес: www.dhf-bg.org  /за България/ и на www.thf.org – за програмите в другите страни.

 

News

 

In March 2001, a Global Health Conference was organized by Dreyfus Health Foundation in the UK. Country coordinators of PSBH and CBH programs participated.

Regional coordinators Dr. Jan Sobotka (Europe and the Middle East), Dr. Daniel Becker (Latin America and the Caribbean), Madame On Ning (Asia), Mrs. Ruth Chikasa (Africa) and Mrs. Marsha Copeland-Jacks (USA) presented the achievements of programs in the countries of their regions.

During the small group and plenary sessions problems and perspectives of the programs were discussed.

The participants in the conference were addressed by Mr. Jack Dreyfus. His book – “ A Remarkable Medicine Has Been Overlooked” was presented, and he spoke about his experience in promoting phenytoin as a medicine of choice for broad range of disorders.

Mr. Dreyfus met in person all participants who had implemented phenytoin projects. Bulgarian participants in this session were Assoc. Prof. Maria Alexandrova, and Dr. Kamen Kamenov. Dr. Kamenov presented Mr. Dreyfus with a CD copy of the Bulgarian translation of The Broad Range of Clinical Use of Phenytoin.

Those willing to read the translation can find it on the INTERNET in the web-site of the Bulgarian program: http://www.dhf-bg.org/

 

Activities planned

 

A PSBH workshop will be held in Stara Zagora in early May, 2001, for which 42 participants have applied.

Follow-up workshops are to take place in Gabrovo on June 12 for Gabrovo Initiative for Better Health projects, and in Varna, on June 14, at which PSBH projects on drug abuse prevention will be presented

Meetings to discuss future PSBH workshops will be organized with representatives of organizations to organize seminars in Pleven (Augist 2001) and Sofia (September 2001).

For more information about Dreyfus Health Foundation programs in Bulgaria please visit our website: http://www.dhf-bg.org/.

 

 

ОНКОЛОГИЧНАТА ПОМОЩ В УСЛОВИЯТА НА ЗДРАВНАТА РЕФОРМА В БЪЛГАРИЯ – ТЕНДЕНЦИИ, ПЕРСПЕКТИВИ И ПРИОРИТЕТИ

 

Д-р Г. Байчев, Онкологичен център, МБАЛ – Плевен

 

     Резюме: Разглеждат се настоящето състояние и тенденции  в онкологичната помощ в контекста на здравната реформа в България. В статията се представя виждането за актуалните цели, приоритети и организационни аспекти пред раковия контрол.

 

     Summary: The current status and tendencies in oncology care are considered in view of the health reform in Bulgaria. The article presents views on actual objectives, priorities and organizational aspects of cancer control.

 

     Key words: oncology; health care reform

 

     На прага на третото хилядолетие България е изправена пред необходимостта да извърши дълбоки реформи в здравеопазването.

     Огромните трудности в процеса на формулирането на нова здравна политика, специфична за преходния период, са не само защото не сме добре подготвени в политическо, финансово и административно отношение, но и защото не съществуват концепции, отразяващи уникалния характер на миналото и на бъдещия процес на прехода.

     I Анализ на съществуващото състояние (преди началото на реформата).

     1.Социално-икономически условия

     - икономическа и морална-етична криза в държавата и обществото;

     - държавен монопол в здравеопазването без обратна информация за изразходваните средства и анализ на дисбалансите;

     - разпределение на финансите най-често не по приоритети, а според натиска на моментните потребности;

     - остаряла нормативна база.

     2. Демографско и здравно състояние на населението

     - застаряване с намаляване на общата продължителност на живота и тенденция за траен отрицателен естествен прираст;

     - ниска здравна култура и стил на живот, генериращ ракови заболявания: тютюнопушене, стрес, нерационално хранене, влошаваща се сексуална култура;

     - ежегодно увеличаваща заболеваемост от онкологични заболявания (310,6/100 000 за 1996 г.). Мъжете най-често боледуват от рак на белия дроб, стомаха и простата, а при жените на първо място е карциномът на млечната жлеза, следван от този на маточното тяло и маточната шийка;

     - тенденция за “подмладяване” на някои туморни локализации;

     - висок относителен процент на новодиагностицираните случаи в III и IV стадий, когато ефекта от лечебната тактика е незадоволителен. Факти: 83,8 % от случаите с карцином на белия дроб, 77,3 % от стомаха, 52,7 % от рака на правото черво се откриват в напреднал стадий (2);

     - нарастваща смъртност от онкологични заболявания (194,2/100 000 за 1996 г.). Карциномът е най-честата причина за смърт при жени в трудоспособна възраст: 34,5 % от всички починали във възрастта 15-54 г. Спрямо болните в САЩ у нас е над 2,5 пъти по-ниска 5-годишната преживяемост при рак на простатата, дебелото и право черво, малигнен меланом, а умерено по-ниска е преживяемостта при рак на гърдата, маточната шийка, пикочния мехур, тестиса, щитовидната жлеза (2).

     3. Състояние на дейността на онкологичната помощ.

     - липсва национална програма за борба с рака;

     - налице е съвременна онкологична доктрина, която обаче не се спазва от мнозина, които диагностицират и лекуват злокачествени заболявания (5);

     - структурно добре развита специализирана онкологична мрежа, на входа на която обаче постъпват лимитирани средства, а очакванията на изхода са за голямо количество и то безплатни услуги. В резултат на това се създават условия за намаляване на качеството на медицинската помощ и обезценяване на лекарския труд;

     - освен провежданите фирмени симпозиуми липса на диалог по същество по актуални проблеми вътре в онкологична колегия;

     - символично финансиране на научната дейност;

     - с изключение на две локализации (бял дроб и млечна жлеза) липсват съвременни дългосрочни прогнозни изследвания за тенденциите в онкологичната заболеваемост, които да позволяват перспективно планиране на здравната политика, а именно: профилактични мероприятия, скрининг, капацитет за диагностика, лечение и рехабилитация;

     - неравномерно представено студентско обучение по проблемите на онкологията в различните медицински университети;

     - бавно утвърждаване на съвременната концепция за качество на живот и палиативни грижи;

     - налице е подкрепа от страна на неправителствени организации и масмедии;

     - съществува тенденция за активизиране на международното и регионално сътрудничество;

     Анализът на състоянието показва влошен здравен статус на населението от онкологична гледна точка и необходимост от промени в подхода към него, както и промени в структурата, финансирането и управлението на онкологичната помощ, съобразени със започналата здравна реформа в България.

     II Основни приоритети на онкологичната помощ в условията на здравната реформа

     От решаващо значение за стартиралата реформа като цяло, и в частност за онкологичната мрежа е рязкото повишаване на ефективността на здравеопазната система, или с други думи да се повиши стойността на отношението “резултат-ресурси”. Това изисква високо компетентно виждане на проблемите и определяне на ясни и високоприоритетни цели. Водещ критерий за оценката на всяка здравна организация ще бъде постигането на приоритетни цели (респ. резултати)  чрез приоритетно разпределени и изразходвани ресурси (1,6).

     Стриктното съобразяване с тези изисквания има жизнено важно значение при сегашните условия на значителен процент неудовлетворени здравни потребности на населението, организационно-управленски дестабилитет на здравната система и на ограниченост на финансовите средства.

     1. Типове здравни приоритети в онкологичната помощ.

     - значими здравни проблеми, изискващи предимствено решаване – напр. ниска здравна култура, липса на действащи скринингови програми за най-честите злокачествени заболявания;

     - значими сектори и дейности, изискващи развитие – напр.курсове за обучение на общопрактикуващите лекари по онкология, промоция на здравето и др.

     - рискови групи от населението, изискващи гарантиране на здравни грижи – жени в климактериум, дългогодишни работници в производства с канцерогени и др.

     2. Критерии за определяне на приоритетите

     Основен критерий за определяне на приоритетите на онкологичната помощ са здравните потребности (респ.неблагоприятния здравен статус) на населението в тяхната динамика. Свързани и подчинени на него са и останалите три критерия:

     - наличните ресурси

     - очаквания и предпочитания на населението

     - степен на доказана ефективност на здравните дейности (методи)

     Интегрален израз на водещите приоритети на оперативно ниво (микрониво) следва да бъдат здравните мероприятия с онкологична насоченост, включени в базовия пакет услуги (първична медицинска помощ).

     Интегрален израз на водещите дългосрочни приоритети на стратегическо национално ниво (макрониво) следва да бъде Националната здравна карта на България (1).

     III Основна цел и задачи пред онкологичната помощ

     Цел:

     Да се преустанови тенденцията за късно диагностициране и нарастване на смъртността от най-честите ракови заболявания (рак на млечната жлеза, маточната шийка , простата и колоректален карцином) и да се създадат условия за подобряване здравето и жизненото дълголетие на нацията.

     Задачи:

     1. Ориентация на онкологичната помощ от грижа за болните към  грижа за здравето (4)

     - програма за промоция на здраве и профилактика на ракови заболявания;

     - оздравяване на околната среда;

     - здравословен начин на живот (намаляване на тютюнопушене, рационално хранене);

     - ограничаване на вторични рискови фактори (затлъстяване, стрес).

     2. Структурна промяна на онкологичната мрежа в духа на провеждащата се национална реформа – от държавен монопол и развитие само на силно специализирана клинична медицинска помощ към преразпределение на дейностите и отговорностите на нива първична, специализирана извънболнична и болнична помощ. Осъществяване на дейността според правилата на добрата медицинска практика и стандартите за лечение при спазване на професионалната тайна и правата на пациента. Осигуряване на възможност за балансиране на териториалните диспропорции (райони с повишена заболеваемост, по-възрастно население и висока безработица) (3).

     3. Преминаване от финансиране на структури към финансиране на дейности и резултати, като се използват и допълват възможностите и на трите сектора: държавен, обществено-осигурителен и частен. Въвеждане на регулирани пазарни механизми при разпределението на ресурсите с оглед на:

     - създаване на конкурентна среда;

     - повишаване качеството на онкологичната помощ;

     - даване на възможност за частна инициатива.

     4. Реформа в управлението: от централизация и администриране към медицинска помощ, реализираща се на базата на закони и на основата на договори (контрактинг-модел). Споделяне на отговорностите между институциите, обществото, гражданите и медицинските професионалисти.

     5. Създаване на система за акредитиране на заведенията, оказващи онкологична помощ (болници за активно лечение, диспансери, болници за хронично болни, хосписи, медико-социални центрове и др.), основана на съвременните стандарти и даваща възможност за мониторинг и управление на качеството на извършваната дейност.

     6. Промени с онкологична насоченост в медицинското образования на нива университетско обучение, специализация и продължителна медицинска квалификация. Известно е, че университетските болници струват повече (и като финансиране и като водещи структури в здравеопазната система), поради мисията, която изпълняват – обслужване на по-сложни и по-тежки случаи, защото са технологично и кадрово по-напреднали от неуниверситетските, провеждане на научни изследвания и обучение по медицина. Това налага онкологията да заема важно място в техните програми и практическа дейност.

     IV Изпълнители на конкретните мероприятия

     Съобразно източниците на финансов ресурс, ангажиментите следва да бъдат разпределени както следва:

     1. Държавен сектор: здравна просвета; медицинско образование; финансиране на научната дейност; лекарствена политика: есенциални препарати за химио- и хормонотерапия; здравна администрация; статистика; международно сътрудничество

     2. Обществено-осигурителен сектор – Национален рамков договор.

     - базов пакет медицински грижи (вкл. с онкологичен характер): за първична извънболнична помощ; за специализирана извънболнична помощ; за болнична помощ

     - лекарствени средства, заплащани от фонда

     На този начален етап на реформата (условно първите 3 – 5 години) гамата от услуги с онкологичен характер, които се очакват от общопрактикуващите лекари е уместно да бъде стеснена.

     Специалистите, които лекуват по-голям брой пациенти с определен вид заболяване (напр. на млечните жлези) могат да свършат по-добра (по-качествена) работа от GP. С натрупването на опит от последните, спазвайки правилата на добрата клинична практика по онкология те постепенно ще могат да оказват широкообхватни, превантивни, последователни във времето и ефективни от гледна точка на разходите грижи и ще координират обслужването на пациентите.

     Приоритетите на задължителното здравно осигуряване (НЗОК) са по същество национални здравни приоритети и следва да бъдат определяни по-глобално и дългосрочно в национални рамки върху основата на обосновани стратегически виждания. Като такива те би следвало да субординират другите форми и елементи на българското здравеопазване – доброволно осигуряване, промоция на здравето и др. (1, 4).

     3. Частен сектор (частни здравни застраховки, плащания “кеш”)

     - екстри и допълнителни услуги – например пластична хирургия след мастектомия

     Трябва да се подчертае, че без ясна програма и точно формулирани приоритети, отчитащи настоящите реалности, цели и интереси, националната ни здравеопазна система  и в частност онкологичната помощ ще бъдат застрашени от хаос и неефективно изразходване на ресурсите. Очевидно тук се крие и най-голямото предизвикателство пред здравната политика и мениджмънта на здравеопазването в процеса на провежданата реформа (1, 6). 

 

Книгопис:

     1. Борисов, В., Зл. Петрова. Управление на приоритети – управление чрез приоритети. Медицински мениджмънт и здравна политика, 31, 2000, 1, 3-9

     2. Данон, Ш. Преживяемост при най-лечимите злокачествени заболявания. VI Национален конгрес по онкология, София, 19-20 ноември 1999

     3. Закон за лечебните заведения. Държавен вестник, 62, 1999

     4. Национална здравноосигурителна каса. Национален рамков договор. Държавен вестник, 107, 2000

     5. Черноземски, Ив. Българската онкология в навечерието на 21 век. VI Национален конгрес по онкология, София, 19-20 ноември, 1999

     6. Banoob, SN. Reforme sanitaire en Europe centrale et orientale: financement public ou private? Forum mondial de la Sante. 15, 1994, 4, 351-357

 

Medline Information

 

Breast Cancer

 

AU:   Lee-Feldstein A, Feldstein PJ, Buchmueller T, Katterhagen G

AD:   Center for Health Policy and Research, Department of Medicine, College of Medicine, University of California, Irvine, 92697-5800, USA. amfeldst@uci.edu

TI:    The relationship of HMOs, health insurance, and delivery systems   to breast cancer outcomes

SO:   Med Care. 2000 Jul. 38(7). P 705-18.

AB:   BACKGROUND: The current climate of anger and frustration with managed care has heightened interest in the quality of health care provided by managed-care plans, particularly health maintenance organizations (HMOs). This breast cancer outcomes study, investigating relationships of health insurance and delivery systems to stage at diagnosis, treatment selected, and survival, is based in a heavily penetrated, highly competitive HMO market. METHODS: Data for 1,788 residents of northern California younger than 65 years of age at diagnosis ( 1987-1993) were provided by a population-based cancer registry. Patient insurance included fee-for-service (FFS), group-model HMO, nongroup HMO, publicly insured, and uninsured. Diagnosis and treatment occurred in 73 hospitals ( large, medium/moderately small, or very small community, rural, teaching, or HMO-owned hospitals). Regression models examined relationships of insurance and hospital type to 3 outcomes (stage, treatment, and survival), controlling for age, ethnicity, education, neighborhood occupational class, and time period. RESULTS: Early diagnosis was as likely for group-model and nongroup-model HMO-insured patients as for the private FFS-insured patients. In 1987-1990, HMO-owned hospitals were leaders in treating 46% of early-stage breast cancers with breast-conserving surgery plus radiation (BCS+); by 1991-1993, the most significant increases in BCS+ use occurred at teaching and large community hospitals. Survival of group-model HMO, nongroup-model HMO, and FFS patients was not significantly different. Publicly insured/uninsured patients had more stage III/IV disease (OR=2.01, P = 0.006) and greater all-cause mortality (risk ratio 1.46, P = 0.015).  CONCLUSIONS: Group-model and nongroup-model HMO patients are similar to FFS-insured patients in stage at diagnosis and survival outcomes. Treatment selection is related to hospital type rather than insurance coverage.

 

    

AU:   Green BL, Krupnick JL, Rowland JH, Epstein SA, Stockton P, Spertus I, Stern N

AD:   Department of Psychiatry, Georgetown University, Washington, DC, USA.
 greenb@gunet.georgetown.edu

TI:    Trauma history as a predictor of psychologic symptoms in women with breast cancer.

SO:   J Clin Oncol. 2000 Mar. 18(5). P 1084-93.

AB:   PURPOSE: To identify predictors of psychiatric problems in women with early-stage breast cancer. PATIENTS AND METHODS: One hundred sixty women with early-stage breast cancer were recruited from three treatment centers. They filled out self-report questionnaires, including a medical history and demographic survey, the Trauma History Questionnaire, Life Event Questionnaire, Brief Symptom Inventory, Beck Depression Inventory, and Duke-UNC Functional Social Support Questionnaire, and were evaluated using the Structured Clinical Interview for DSM-III-R. RESULTS: Hierarchical regression analyses indicated that four of five variable sets made a significant incremental contribution to outcome prediction, with 35% to 37% of the variance explained.  Outcomes were predicted by demographic variables, trauma history variables, precancer psychiatric diagnosis, recent life events, and perceived social support. Cancer treatment variables did not predict outcome. CONCLUSION: The findings highlight the important roles of trauma history and recent life events in adjustment to cancer and have implications for screening and treatment.

 

 

AU:   Farmer AJ

AD:   Wessex Cancer Trust, Southampton, England.

TI:    The minimization to clients of screen-detected breast cancer: a qualitative analysis.

SO:   J Adv Nurs. 2000 Feb. 31(2). P 306-13.

AB:   Previous research has shown a low incidence of psychological morbidity in women with screen-detected breast cancer when compared to women with symptomatic breast cancer. Farmer et al. suggested that this might be due to the way the diagnosis of breast cancer is given to women with screen-detected disease. In order to test this hypothesis a detailed, in-depth, qualitative study was undertaken. The sample consisted of women with symptomatic breast cancer (n=5), women with screen-detected invasive breast cancer (n=6) and women with screen-detected in-situ breast cancer (n=5). The ‘bad news consultations’ with the surgeons, and subsequent meetings with the breast care nurses (BCN), were tape recorded. The women were also interviewed in their own homes within 7 days. The results suggested that the women with screen-detected breast cancer received more reassurance than the women with symptomatic breast cancer and that the benefits of breast screening were emphasized by the surgeons and the BCNs. This led to minimization of the significance of screen-detected disease. Women were found to draw on a new conceptual model of early curable breast cancer which appears to be associated with a low incidence of psychological morbidity.

 

 

AU:   Caplan LS, May DS, Richardson LC

AD:   Epidemiology and Health Services Research Branch, Centers for Disease Control and Prevention, Atlanta, Ga. 30341, USA. lhc9@cdc.gov

TI:    Time to diagnosis and treatment of breast cancer: results from the National Breast and Cervical Cancer Early Detection Program, 1991-1995.

SO:   Am J Public Health. 2000 Jan. 90(1). P 130-4.

AB:   OBJECTIVES: This study examined times to diagnosis and treatment for medically underserved women screened for breast cancer. METHODS: Intervals from first positive screening test to diagnosis to initiation of treatment were determined for 1659 women 40 years and older diagnosed with breast cancer.  RESULTS: Women with abnormal mammograms had shorter diagnostic intervals than women with abnormal clinical breast examinations and normal mammograms. Women with self-reported breast symptoms had shorter diagnostic intervals than asymptomatic women. Diagnostic intervals were less than 60 days in 78% of cases. Treatment intervals were generally 2 weeks or less. CONCLUSIONS: Most women diagnosed with breast cancer were followed up in a timely manner after screening.  Further investigation is needed to identify and then address factors associated with longer diagnostic and treatment intervals to maximize the benefits of early detection.

 

 

AU:   Alexander FE, Anderson TJ, Brown HK, Forrest AP, Hepburn W, Kirkpatrick AE, Muir BB, Prescott RJ, Smith A

AD:   Department of Community Health Sciences, University of Edinburgh, UK.
 freda.alexander@ed.ac.uk

TI:    14 years of follow-up from the Edinburgh randomised trial of breast-cancer screening

SO:   Lancet. 1999 Jun 5. 353(9168). P 1903-8.

AB:   BACKGROUND: The Edinburgh randomised trial of breast-cancer screening recruited women aged 45-64 years from 1978 to 1981 (cohort 1), and those aged 45-49 years during 1982-85 (cohorts 2 and 3). Results based on 14 years of follow-up and 270,000 woman-years of observation are reported. METHODS: Breast-cancer mortality rates in the intervention group (28,628 women offered screening) were compared with those in the control group (26,026) with adjustment for socioeconomic status (SES) of general medical practices. Rate ratios were derived by means of logistic regression for the total trial population and for women first offered screening while younger than 50 years. Analyses were by intention to treat. FINDINGS: Initial unadjusted results showed a difference of just 13% in breast-cancer mortality rates between the intervention and control groups (156 deaths [5.18 per 10,000] vs 167 [6.04 per 10,000]; rate ratio 0.87 [95% CI 0.70-1.06]), but the results were influenced by differences in SES by trial group. After adjustment for SES, the rate ratio was 0.79 (95% CI 0.60-1.  02). When deaths after diagnosis more than 3 years after the end of the study were censored the rate ratio became 0.71 (0.53-0.95). There was no evidence of heterogeneity by age at entry and no evidence that younger entrants had smaller or delayed benefit (rate ratio 0.70 [0.41-1.20]). No breast-cancer mortality benefit was observed for women whose breast cancers were diagnosed when they were younger than 50 years. Other-cause mortality rates did not differ by trial group when adjusted for SES. INTERPRETATION: Our findings confirm results from randomised trials in Sweden and the USA that screening for breast cancer lowers breast-cancer mortality. Similar results are reported by the UK geographical comparison, UK Trial of Early Detection of Breast Cancer. The results for younger women suggest benefit from introduction of screening before 50 years of age.

 

 

AU:   Burstein HJ, Gelber S, Guadagnoli E, Weeks JC

AD:   Department of Adult Oncology, Dana-Farber Cancer Institute and      Harvard Medical School, Boston, MA 02115, USA.

TI:    Use of alternative medicine by  women with early-stage breast cancer

SO:   N Engl J Med. 1999 Jun 3. 340(22). P 1733-9.

AB:   BACKGROUND: We analyzed the use of alternative medicine by women who had received standard therapy for early-stage breast cancer diagnosed between September 1993 and September 1995.  METHODS: A cohort of 480 patients with newly diagnosed early-stage breast cancer was recruited from a Massachusetts statewide cohort of women participating in a study of how women choose treatment for cancer. Alternative medical treatments, conventional therapies, and health-related quality of life were examined. RESULTS: New use of alternative medicine after surgery for breast cancer was common (reported by 28.1 percent of the women); such use was not associated with choices about standard medical therapies after we controlled for clinical and sociodemographic variables. A total of 10.6 percent of the women had used alternative medicine before they were given a diagnosis of breast cancer.  Women who initiated the use of alternative medicine after surgery reported a worse quality of life than women who never used alternative medicine. Mental health scores were similar at base line among women who decided to use alternative medicine and those who did not, but three months after surgery the use of alternative medicine was independently associated with depression, fear of recurrence of cancer, lower scores for mental health and sexual satisfaction, and more physical symptoms as well as symptoms of greater intensity. All groups of women reported improving quality of life one year after surgery. CONCLUSIONS: Among women with newly diagnosed early-stage breast cancer who had been treated with standard therapies, new use of alternative medicine was a marker of greater psychosocial distress and worse quality of life.

 

 

AU:   Wu Y, Weissfeld JL, Weinberg GB, Kuller LH

AD:   Department of Epidemiology (Graduate School of Public Health),University of Pittsburgh, Pennsylvania, USA.

TI:    Screening mammography and  late-stage breast cancer: a population-based study.

SO:   Prev Med. 1999 Jun. 28(6). P 572-8.

AB:   BACKGROUND: Among 50- to 69-year-old women, randomized clinical trials show breast cancer mortality reductions from screening mammography. However, few studies examine the long-term health effects and outcomes from screening mammography in community practice. The purpose of this study was to evaluate one approach for determining the effectiveness of screening mammography, as it is practiced in community settings, and to measure the prevalence of prior screening mammography among women with incident breast cancer. METHODS: This study was a population-based survey of the general community. Participants were 406 women with breast cancer diagnosed in 1993. The main outcome measure was breast cancer, late stage at diagnosis or fatal within 2 to 3 years of diagnosis. RESULTS: Sixty-four ( 57.7%) of 111 women with late-stage and 123 (42.1%) of 292 women with early-stage breast cancer did not have a screening mammogram in the 4 calendar years (1989-1992) before diagnosis . Relative to women with early-stage breast cancer, mammography nonuse in 1989-1992 was significantly more frequent among women with late-stage breast cancer (age-adjusted odds ratio 2.3, 95% confidence interval 1.3-4.3).  Prior mammography was particularly infrequent among 42 women with breast cancer incident in 1993 and fatal before January 1996. CONCLUSIONS: Prior mammography among women with late-stage or fatal breast cancer was relatively infrequent. Late-stage or fatal breast cancer lacking prior mammography constitutes a missed public health opportunity. Also, this population-based study showed the expected association between prior mammography and late-stage or fatal breast cancer. These results are consistent with the effective practice of mammography in a community setting. The results illustrate and validate a public health approach that uses prior mammography histories among women with incident breast cancer to evaluate mammography penetration and quality in defined communities.

 

 

AU:   Sainsbury R, Johnston C, Haward B

AD:   Department of Surgery, Huddersfield Royal Infirmary, UK jrcs@compuserve.com

TI:    Effect on survival of delays in referral of patients with breast-cancer symptoms: a retrospective analysis [see comments]

SO:   Lancet. 1999 Apr 3. 353(9159). P 1132-5.

AB:   BACKGROUND: From April 1, 1999, family physicians are required to refer all patients who have suspected breast cancer in the UK urgently to hospital, to be seen within 14 days of referral. We investigated whether delays by providers in routine practice for diagnosis influence survival. METHODS: We did a retrospective analysis of 36,222 patients with breast cancer listed in the Yorkshire Cancer Registry. Data on delay after family-physician referral, hospital visit, and start of treatment were available, as well as on tumour grade and stage of presentation. RESULTS: There was no evidence that provider delays of longer than 90 days adversely influenced survival.  The time from family-physician referral to first hospital visit changed little (median 10 vs 13 days) from 1976 to 1995, whereas time from first visit to first treatment doubled (7 vs 13 days). More than 8% of patients younger than 50 years delayed longer than 90 days, compared with 3% of patients older than 50 years (p<0.001). 48% of younger patients had their first treatment within 30 days compared with 64% of those older than 50 (p<0.001). The survival for 5708 patients diagnosed in 1986-90 selected for survival analysis was 63% at 5 years, and 51% at 8 years. Patients who presented early and were treated in less than 30 days had significantly worse outcomes (p<0.001). INTERPRETATION: Delays by providers in diagnosis of 3 months or more do not seem to be associated with decreased survival in patients presenting with breast cancer. The drive for all women with possible breast cancer to be seen within 14 days will divert resources from other services and is not supported by this study.

 

 

AU:   Hirose K, Tajima K, Hamajima N, Kuroishi T, Miura S, Tokudome S

AD:   Division of Epidemiology, Aichi  Cancer Center Research Institute, Nagoya.

TI:    Impact of family history on the risk of breast cancer among the Japanese.

SO:   Jpn J Cancer Res. 1997 Dec. 88(12). P 1130-6.

AB:   To assess the impact of family history on the risk of developing breast cancer, a case-referent study was conducted using data from the Hospital-based Epidemiologic Research Program at Aichi Cancer Center (HERPACC), Japan. In total, 1, 551 breast cancer cases were included and 28,450 women, confirmed as free of cancer, were recruited as the reference group. The odds ratios (ORs) and their 95% confidence intervals (95% CIs) were estimated by using an unconditional logistic regression model. Stratification by age at diagnosis was done to evaluate the impact of family history on early (< 40 years of age) vs. later (> or = 40 years of age) onset. New findings obtained from the present study were as follows. 1) For women having a family member with ovarian cancer, the OR for breast center diagnosed under age 40 was 5.04 (95% CI: 1.48-17.1). 2) The effect of family history on the risk of breast cancer was greater when a sister(s) was (were) positive (OR = 3.51) than when the mother was positive (OR = 1.47). 3) The estimated proportional ratio (PR) for breast cancer was 2.63 ( 95% CI: 2.05-3.38) among sisters excluding probands, while PR for cancers other than breast cancer was 1.09 (95% CI: 0.94-1.  27). This result suggested that a family history of breast cancer, especially among sisters, elevated the risk of developing breast cancer. Furthermore, when women had a sister( s) with breast cancer diagnosed prior to 40 years of age, their family history of breast cancer affected their risk of cancer of the breast and other organs.

 

 

AU:   Beitler AL, Hurd TC, Edge SB

AD:   Division of Surgical Oncology and Endoscopy, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.

TI:    The evaluation of palpable breast masses: common pitfalls and management guidelines.

SO:   Surg Oncol. 1997 Dec. 6(4). P 227-34.

AB:   The management of a palpable breast mass starts with identification of the lesion and a suspicion of malignancy.  While seemingly simple, the initial evaluation can significantly impact upon treatment options and outcomes. The management of two patients recently referred to this Institution highlights common pitfalls and technical considerations in the diagnosis and treatment of palpable breast masses. The case histories of two patients referred after open breast biopsy were examined. The English language medical literature was searched manually and by Medline for publications related to the evaluation of palpable breast masses. Imaging, diagnostic techniques and technical considerations in the management of palpable lesions were reviewed. The initial use of carefully selected diagnostic and therapeutic measures is critical in optimizing outcomes measured in improved quality of life and survival.  Inappropriate choices at this first stage can have extremely negative consequences. The early evaluation of two patients highlighted these considerations. Management pitfalls included serial examination of a suspicious lesion, failure to obtain a mammogram prior to excisional biopsy and unnecessary testing.  Technical problems included piecemeal excision of the tumor with positive margins, use of a drain, closure of deep tissues with dimpling of the breast, and incision placement in a location that subsequently necessitated mastectomy. Careful adherence to the clinical and operative principles of breast cancer management optimizes outcomes in the evaluation of palpable breast masses.

 

 

AU:   McCredie M, Paul C, Skegg DC, Williams S

AD:   Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. margaret.mccredie@stonebow.otago.ac.nz

TI:    Family history and risk of breast cancer in New Zealand.

SO:   Int J Cancer. 1997 Nov 14. 73(4). P 503-7.

AB:   A national population-based case-control study was used to assess the influence on breast cancer risk of a family history of the disease and the possibility of an interaction with reproductive risk factors. A total of 891 women aged 25-54 years with a first diagnosis of breast cancer and 1,864 control subjects randomly selected from the electoral rolls were interviewed. Age-adjusted relative risks (RR) of breast cancer were similar for mothers (RR = 2.3) and sisters (RR = 2.  7) but somewhat higher for first-degree (RR = 2.6) than for second-degree (RR = 1.7) relatives. Cases reporting a first- or second-degree relative with breast cancer were no more likely to be diagnosed at an early age than those with no family history. With regard to the age at diagnosis of the relative, the RR was higher if breast cancer had been diagnosed before the age of 45 years than later; this was true for first-degree as well as for second-degree relatives. In women with no family history, the falling RRs with increasing age at menarche reflected the usual pattern, but no such trend was apparent in those reporting a mother or sister with breast cancer. For age at first full-term pregnancy, parity, breast-feeding, menopausal status, infertility, history of benign breast disease and body mass index, no evidence was seen of effect modification by a family history of breast cancer.  Mothers of cases had about twice the cumulative rate of breast cancer as mothers of controls, a similar difference being seen between sisters of cases and sisters of controls.

 

 

AU:   Collins C, Davis LS, Rentz K, Vannoy D

AD:   College of Nursing and Health, University of Cincinnati, Ohio 45221-0038, USA.

TI:    Influence of advertisement on women’s attitudes toward     mammography screening.

SO:   Issues Ment Health Nurs. 1997 Nov-Dec. 18(6). P 603-21.

AB:   This project represents an effort to incorporate a feminist perspective into research on mammography screening. The purpose of this study was to assess women’s attitudes toward four advertisements designed to encourage mammography screening. The goal was to create awareness about women’s attitudes toward mammography advertisements in order to encourage the development of more effective and responsive motivational materials. The results indicated that each ad communicated different messages about the seriousness of breast cancer and the efficacy of mammography in detecting early breast cancer. Each ad also affected women differently regarding their feelings of control over breast cancer, their perceived loss of sex appeal resulting from a breast cancer diagnosis, and their general fear of breast cancer.

 

 

AU:   Kroman N, Wohlfahrt J, Andersen KW, Mouridsen HT, Westergaard T, Melbye M

AD:   Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen.

TI:    Parity, age at first childbirth and the prognosis of primary breast cancer.

SO:   Br J Cancer. 1998 Dec. 78(11). P 1529-33.

AB:   Reproductive factors are known to be aetiologically important in breast cancer, but less is known regarding their effect on breast cancer prognosis. We have investigated the prognostic effect of age at first birth and total parity using data from the Danish Breast Cancer Cooperative Group that, since 1977, has collected population-based information on tumour characteristics, treatment regimes and follow-up status on Danish women with breast cancer. Details of pregnancy history were added from the Danish Civil Registration System and the National Birth Registry. Included in the study were 10,703 women with primary breast cancer. After adjusting for age and stage of disease (tumour size, axillary nodal status and histological grading), the number of full-term pregnancies was found without prognostic value. However, women with primary childbirth between 20 and 29 years experienced a significantly reduced risk of death compared with women with primary childbirth below the age of 20 years [20-24 years: relative risk (RR) = 0.88, 95% confidence interval (CI) 0.78-0.99; 25-29 years: RR = 0.80, 95% CI 0.70-0.91]. Further adjustment for oestrogen receptor status did not influence these results. The effect was not modified by age at diagnosis, tumour size or nodal status. In conclusion, low age at first childbirth, but not parity, was associated with a poor prognosis of breast cancer. We speculate whether women who develop breast cancer despite an early first full-term pregnancy might represent a selected group with a more malignant disease.

 

 

AU:   Yokoe T, Iino Y, Maemura M, Takei H, Horiguchi J, Matsumoto H, Morishita Y, Koibuchi Y

AD:   Department of Emergency and Critical Care Medicine, Gunma University School of Medicine, Japan.

TI:    Efficacy of mammography for detecting early breast cancer in women under 50.

SO:   Anticancer Res. 1998 Nov-Dec. 18(6B). P 4709-11.

AB:   Screening mammography (MMG) for women aged 50 years and older has been widely accepted all over the world. However, the efficacy of screening mammography for women aged under 50 years has not been established. We compared mammographic findings of the patients under age 50 (the younger group) and those of patients 50 and older (the older group). From 1992 to 1997, 107 patients with early breast cancer (non-invasive and Stage I) were treated in our hospital. There was no difference between the groups in background. Of 53 patients in the younger group, 40 (75.5%) were diagnosed as having cancer using mammography, while 44 of 54 (81.5%) of the older group were diagnosed as having cancer. A total of 46 (86.8%) patients in the younger group were diagnosed using MMG and physical examination (PE), and 50 (92.6%) in the older group were diagnosed as cancer using MMG and PE. There was no difference in the successful diagnosis rate using mammography in the two groups. Breast cancer screening using MMG may also be useful for women aged under 50.

 

 

AU:   Miltenburg GA, Peeters PH, Fracheboud J, Collette HJ

AD:   Julius Centre for Patient Oriented Research, Medical School, Utrecht University, The Netherlands.

TI:    Seventeen-year evaluation of breast cancer screening: the DOM project, The Netherlands. Diagnostisch Onderzoek (investigation) Mammacarcinoom.

SO:   Br J Cancer. 1998 Oct. 78(7). P 962-5.

AB:   The DOM project is a non-randomized population-based breast cancer screening programme in Utrecht which started in 1974-75. The 17-year effect has been evaluated by a case-control study of breast cancer deaths during the period 1975-92 in women living in the city of Utrecht, born between 1911 and 1925, whose breast cancers were diagnosed after the initiation of the DOM project. Controls (three for each case) were defined as women having the same year of birth as the case, living in the city of Utrecht at the time the case died, and having had the opportunity of screening in the DOM project.  Screening in the period 1975-92 indicated a breast cancer mortality reduction of 46% (odds ratio of 0.54, 95% confidence interval 0.37-0.79). The strongest protective effect was found at a screening interval of 2 years or less (mortality reduction of 62%, odds ratio of 0.38), and for the highest number of screens (mortality reduction of 68%, odds ratio of 0.  32 for more than four screens). Exclusion of breast cancer deaths that occurred within 1 year of diagnosis, to allow for ‘ lead-time’ bias, gave an odds ratio of 0.61. Early diagnosis of breast cancer by screening reduces breast cancer mortality in the long term. Bias due to the study design may slightly overestimate the protective effect. A screening programme with a 2-yearly, or smaller, interval between successive screens will improve the protection of screening.

 

 

AU:   Espiяe M

AD:   Centre des Maladies du sein, Hяopital St Louis, Paris.

TI:    [Treatment of breast cancer]

SO:   Presse Med. 1998 Sep 12. 27(26). P 1332-5.

AB:   EPIDEMIOLOGY IN FRANCE: Breast cancer causes 11,000 deaths annually in France and 25,000 new cases are diagnosed each year. Currently, the overall survival rate is 73% at 5 years and 59% at 10 years. Treatment and outcome depend largely on stage at diagnosis and metastatic extension, but many questions remain open. NON-METASTATIC BREAST CANCER: Breast conserving tumorectomy with nodal dissection and radiation therapy is the rule for small tumors measuring less than 3 cm, although there is still some debate on safety margins and the appropriate attitude in case of invasion. Likewise, there are arguments both for and against primary chemotherapy before tumorectomy. Currently, primary chemotherapy should be given in all cases of inflammatory cancers and preferentially for large tumors. Nodal dissection is essentially a diagnostic procedure and is almost always performed although trials evaluating the value of the sentinel node may have an effect on current attitudes. Despite recent advances in adjuvant therapy, dose and combination of chemotherapy are still open questions. There is however a consensus that chemotherapy should be prescribed for all premenopausal patients with node negative and adverse prognosticators and for all patients under 70 with nodal invasion associated with hormonotherapy after menopause if hormone receptors are positive. METASTATIC BREAST CANCER: At this stage, remission together with quality of life are the primary treatment goals. The best response rates (around 65%) are obtained with polychemotherapy protocols including anthracyclins and complete remission can be obtained in approximately 15% of the patients. There is some hope that chemoresistance may be curtailed with new agents such as vinorelbin or the taxane family. High-dose chemotherapy with hematopoietic rescue is another avenue of research aimed at reducing chemoresistance and improving survival. Overall response to hormone therapy is around 30%.  Response rate peaks near 70% in cases positive for estrogen and progesterone receptors, but falls to only 10% if hormone receptors are absent. The role of new hormone therapies using new antiestrogen and antiaromatic compounds remains to be determined. AN ONGOING CHALLENGE: Mortality due to breast cancer has started to decline in developed countries despite increasing incidence. This reduction is undoubtedly related to advances in hormone therapy and adjuvant chemotherapy but also to screening programs and early diagnosis. In the Scandinavian countries, it has been demonstrated that mortality can be reduced to the order of 30 to 40% with mass screening, a challenge which should be met in France.

 

 

AU:   de Paredes ES, Langer TG, Cousins J

AD:   Department of Radiology, Medical College of Virginia of Virginia Commonwealth University, USA.

TI:    Interventional breast procedures.

SO:   Curr Probl Diagn Radiol. 1998 Sep-Oct. 27(5). P 133-84.

AB:   The capability to provide histologic diagnoses of nonpalpable

lesions by performance of percutaneous needle biopsy has revolutionized breast imaging in the past decade. The radiologist who performs percutaneous breast biopsies assumes an increased level of responsibility for the patient regarding patient selection, lesion selection, performance of the biopsy procedure, interpretation of results, and patient follow-up.  With variable and increasingly numerous options for the biopsy of breast lesions, careful attention must be paid to the selection of patients and types of lesions for different procedures. Critical technical considerations affect whether biopsy of a lesion can be optimally performed percutaneously, and these considerations must be factored into the recommendations for patient treatment. In addition, a limited preprocedural clinical assessment of the patient will allow a safer procedure to be performed expeditiously. Most breast abnormalities classified by using the ACR Lexicon as 4 ( suggestive) or 5 (highly suggestive, likely malignant) are suitable for either percutaneous breast needle biopsy or needle localization and excisional biopsy. In general, those lesions classified as 3 (probably benign) carry a recommendation for early follow-up and not biopsy, because the likelihood of malignancy is small. A particular advantage of percutaneous biopsy is in the diagnosis of multicentric breast cancer. Core biopsy is less invasive and less costly than surgical biopsy, and it can be used to demonstrate multicentric disease, saving the patient a two-step surgery. However, several lesions are better treated by excision than by percutaneous biopsy. Among these are architectural distortion or loosely arranged, segmental or regional microcalcifications. For nonpalpable breast lesions visualized on mammography, sonography, or both, imaging-guided localization is required for precise needle placement either for wire localization or for percutaneous breast biopsy. The selection of which modality to use for guidance depends on (1) the adequacy of visualization of the lesion by the modality used, (2) the position of the lesion, (3) the ease of positioning the patient, (4) the skill of the operator, (5) the need to reduce radiation exposure, (6) the overall patient condition, and (7) size of the lesion. Fine-needle aspiration biopsy (FNAB) has a high sensitivity and specificity in the diagnosis of palpable breast lesions when the procedure is properly performed and interpreted. Variable results have been achieved with FNAB of nonpalpable breast lesions under imaging guidance. Three critical components are necessary to achieve reliable results by using FNAB. These include the following: (1) accuracy in needle placement, (2) skill in performance of FNAB, and (3) expert cytopathologic analysis. Accurate preoperative needle localization of nonpalpable breast lesions allows the radiologist to guide the surgeon performing an open biopsy and helps to ensure that the surgical procedure can be performed quickly and can be accomplished with the best possible cosmetic result for the patient. Lesions selected for needle localization and biopsy should undergo a complete tailored imaging evaluation before the needle localization is scheduled. Specimen radiography should be performed for all nonpalpable lesions. Once the lesion has been identified on specimen radiography, the radiologist can assist the pathologist in identifying the lesion microscopically by marking the lesion within the surgical specimen. We cover the technical and interpretative aspects of percutaneous breast biopsy and needle localization for surgical biopsy.

 

 

Colorectal Cancer

 

AU:   Rembacken BJ, Fujii T, Cairns A, Dixon MF, Yoshida S, Chalmers DM, Axon AT

AD:   Centre for Digestive Diseases, The General Infirmary, Leeds. BJR@firstnet.co.uk

TI:    Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK.

SO:   Lancet. 2000 Apr 8. 355(9211). P 1211-4.

AB:   BACKGROUND: Flat and depressed colorectal tumours were originally thought to be unique to the Japanese population. Recently there have been reports of flat and depressed lesions in western countries but they have been thought to be uncommon. METHODS: In this prospective study, 1000 consecutive patients attending for routine colonoscopy were examined for flat or depressed lesions. The examinations were done by one European colonoscopist using methods developed in Japan. FINDINGS: 321 adenomas were found: 202 (63%) were polypoid, 36% (117) were flat and 2 (0.6%) appeared depressed. Most adenomas contained areas of mild or moderate dysplasia but 10% (31) were severely dysplastic. Six Dukes’ A adenocarcinomas were identified together with 25 more advanced adenocarcinomas. The likelihood of Dukes’ A cancer or severe dysplasia increased from 4% (3/70) in small flat lesions, to 6% (9/154) in small polyps, 16% (8/50) in larger polyps, 29% (14/49) in large flat lesions, and 75% (3/4) in depressed lesions. 54% (20/37) lesions containing severe dysplasia or Dukes’ A carcinoma were flat or depressed. INTERPRETATION: The polyp-carcinoma hypothesis prompts colonoscopists to search only for polypoid lesions when screening for cancer, and many early colorectal neoplasms may therefore be missed. Colonoscopists require training in the recognition of flat and depressed lesions to detect colorectal tumours in the early stages.

 

 

AU:   Hronek M, Zadak Z, Solichova D, Jandik P, Melichar B

AD:   Faculty of Pharmacy, Charles University, Hradec Kralove, Czech Republic. hronek@faf.cuni.cz

TI:    The association between specific nutritional antioxidants and manifestation of colorectal cancer.

SO:   Nutrition. 2000 Mar. 16(3). P 189-91.

AB:   Determination of specific antioxidants for examination of oxidative balance and immune responses may be of value in the early diagnosis of colorectal cancer. In the present report, we investigated urinary excretion of zinc, copper, and neopterin and serum levels of vitamins A, C, and E in 30 patients (age = 64 +/- 12 y) with colorectal cancer at the time of diagnosis and in 30 control subjects (age = 61 +/- 11 y) with benign disorders not associated with a systemic inflammatory response. Urinary excretion of zinc, copper, and neopterin was significantly elevated, and serum concentration of vitamin A was decreased in patients with colorectal cancer; these changes are characteristics of systemic immune activation. These phenomena may be of use for the detection of tumor progression and immune response to neoplasm.RN: 0 - Antioxidants; 11103-57-4 - Vitamin A; 1406-18-4 - Vitamin E; 50-81-7 - Ascorbic Acid; 670-65-5 - Neopterin; 7440-50-8 - Copper; 7440-66-6 - ZincEM: 0006

 

 

AU:   Scheiden R, Sand J, Pandin M, Wagener Y, Capesius C

AD:   Morphological Tumor Registry, Luxembourg, Luxembourg.

TI:    Colorectal high-grade adenomas: incidence, localization and adenoma-adenocarcinoma ratio in a retrospective and comparative population-based study of 225 consecutive cases between 1988 and 1996.

SO:   Int J Colorectal Dis. 2000 Feb. 15(1). P 29-34.

AB:   Colorectal high-grade adenomas can be regarded as precancerous lesions. This study collected epidemiological data from a defined region (Luxembourg) that can serve as reference data for designing a national screening program for early colorectal cancer detection. Nine pathologists diagnosed and reviewed slides retrospectively from 288 new colorectal and anal in situ carcinomas from the period 1988-1996 (63 were excluded for various reasons). In all, 225 new colorectal high-grade adenomas were considered. There were 129 men (57%) and 96 women (42%), and 78% of patients were aged over 60 years. Over this period we found an increase in incidence of high-grade colorectal adenomas (11 cases in 1988, 40 cases in 1996) for both sexes. The overall incidence rate was 2.9 x 100,000 in 1988 and 9.6 x 100,000 in 1996. The average annual age-standardized incidence rate for this period was 3.7+/-0.5 (95% confidence interval); the cumulative rate (0-74 years) was 0.4%. Three-fourths of the adenomas were situated in the rectum (n=78, 35%) or sigmoid colon (n=92, 41%). Histological diagnosis was provided by 160 total polypectomy specimens (71%), 30 surgical resections (13.3%), and 35 biopsy specimens (16%). Over the study period there was an increased incidence of new colorectal adenocarcinomas. There were eight times as many adenocarcinomas (n=1782) as adenomas (n=225); the distribution of anatomical sites was comparable. These epidemiological data on 225 new colorectal high-grade adenomas can be the basis for quality assurance in clinical and histological diagnostic procedures, especially in regard to the 1:8 ratio between high-grade adenomas and invasive adenocarcinomas and may provide additional data for the design of a regional or national colorectal cancer screening program.

 

 

AU:   Pohl C, Hombach A, Kruis W

AD:   Innere Abteilung, Evangelisches Krankenhaus Koeln Kalk, Germany.

TI:    Chronic inflammatory bowel disease and  cancer.

SO:   Hepatogastroenterology. 2000 Jan-Feb. 47(31). P 57-70.

AB:   Colorectal cancer represents the major cause for excess morbidity and mortality by malignant disease in ulcerative colitis as well as in Crohn’s disease. The risk for ulcerative colitis associated colorectal cancer is increased at least 2-fold compared to the normal population and colorectal cancer is observed in 5.5-13.5% of all patients with ulcerative colitis and 0.4-0.8% of patients with Crohn’s disease. Established risk factors include long duration of the disease, large extent of the disease, low activity of the disease, young age at onset, presence of complicating primary sclerosing cholangitis or stenotic disease and possibly lack of adequate surveillance, inadequate pharmacological therapy, folate deficiency and non-smoking. Crohn’s disease is associated with an increased risk of colorectal carcinoma in patients with long-standing disease, strictures and fistulae under the condition that the colon is involved, tumors of the small intestine may occur occasionally. Extracolonic malignancies are rare, with the exception of biliary tract cancer. Ulcerative colitis associated colorectal cancer typically can occur in the entire colon, is often multifocal and of undifferentiated histology. Stage distribution and prognosis of ulcerative colitis associated colorectal cancer appears to be similar to that of sporadic colorectal cancer with an overall survival of about 40% (15-65%) after 5 years with tumor stage at diagnosis being the most important predictive parameter for survival. Tumor markers helpful for the diagnosis of sporadic colorectal cancer fail to differentiate between inflammatory response and malignant transformation. In contrast the histologic evidence of dysplasia was shown to be a strong indicator of underlying carcinoma or developing malignant transformation. The presence of a surface projection termed dysplasia associated lesion or mass is highly indicative of underlying or associated cancer. While the routinely performed search for dysplasia is hampered by high interobserver variation the demonstration of DNA-aneuploidy or genetic changes which may confirm the ongoing malignant transformation has not yet become clinical routine. The genetic alterations found in ulcerative colitis associated colorectal cancer involve many of the same targets found in sporadic colorectal tumors and include multiple sites of allelic deletion, microsatellite instabilities, and mutations of APC, p53, Ki-ras as well as MSH2 and other genes. The progression of dysplasia to carcinoma is generally accompanied by an accumulation of these mutations and the similarities in the biology of colorectal cancer associated with ulcerative colitis and sporadic colorectal cancer appear to outweigh their difference. In regard to the management of dysplasia and cancer, the role of surveillance programs for the early detection of ulcerative colitis associated colorectal cancer at a curable stage is still under debate. Although these programs failed at tumor prevention and lethal carcinomas are still found inadvertently in patients under surveillance, the majority of surveillance programs could reduce mortality by detecting more cancers at a still curable stage. Current recommendations for surveillance include, therefore, biennial colonoscopy with extensive biopsies after 8-10 years of total colitis or after 15-20 years of left-sided colitis. In the presence of cancer or unequivocal high-grade dysplasia and/or dysplasia associated lesion or mass proctocolectomy is considered adequate. The evidence of low-grade dysplasia should be confirmed before proctocolectomy is considered

 

 

AU:   Mayer R, Wong WD, Rothenberger DA, Goldberg SM, Madoff RD

AD:   The Department of Surgery, University of Minnesota and the University of Minnesota Comprehensive Cancer Center, Minneapolis, USA.

TI:    Colorectal cancer in inflammatory bowel disease: a continuing problem.

SO:   Dis Colon Rectum. 1999 Mar. 42(3). P 343-7.

AB:   PURPOSE: Because of the increased risk of colorectal cancer in patients with inflammatory bowel disease, surveillance colonoscopy with mucosal biopsies for dysplasia has been advocated to prevent malignancy or permit its early diagnosis. However, despite adoption of colonoscopic surveillance programs by many clinicians, we have noted a pattern of continued referrals for inflammatory bowel disease-associated malignancy. This study was undertaken in an effort to characterize this cohort of patients. METHODS: We reviewed the operative records of a large metropolitan colorectal practice from 1983 to 1995. During this period 40 large-bowel resections were performed for patients with documented inflammatory bowel disease and concomitant carcinoma. A retrospective analysis was conducted with emphasis on clinical presentation, pathologic description, and most recent follow-up. RESULTS: Mean age at the time of diagnosis of cancer was 48 years with an average inflammatory bowel disease duration of 19 years. Seven patients had documented inflammatory bowel disease for less than eight years before their cancer diagnosis. Carcinomas were identified preoperatively by colonoscopy in 92 percent of patients. One-half of these patients had the colonoscopy to investigate a recent change in inflammatory bowel disease symptoms or signs, whereas the other half underwent endoscopy as routine surveillance. For the remaining 8 percent of patients, operated on for worsening symptoms, the carcinoma was detected in the pathological specimen only. The majority of patients (68 percent) did not have a preoperative diagnosis of dysplasia. Twenty-five percent of tumors were mucinous, 20 percent were multicentric, nd 70 percent were located distal to the splenic flexure. Among the seven patients who died, four had pancolitis, six had a recent worsening of symptoms, and all had cancer involving the rectum. CONCLUSION: Cancer occurs at a younger age in patients with long-standing inflammatory bowel disease. The tumors are often mucinous, multiple, and located in the left colon. Despite increasing acceptance of surveillance colonoscopy as a recommended strategy in cancer prevention, almost one-half of the patients in this study had their cancer diagnosed because increased colitis symptoms led to colonoscopic examination. Eighteen percent of patients developed cancer with less than an eight-year history of inflammatory bowel disease. These data call into question the effectiveness of dysplasia surveillance as a population-based strategy to decrease the colorectal cancer mortality in inflammatory bowel disease patients.

 

 

AU:   Saddler DA, Ellis C

AD:   University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.

TI:    Colorectal cancer.

AB:   OBJECTIVES: To provide a review of the etiology, risk factors, treatment, and nursing care of patients with colorectal cancer. DATA SOURCES: Review articles, screening guidelines, and textbook chapters. CONCLUSIONS: Although colorectal cancer remains a major health threat in the United States, advances made over the last 10 years in prevention, diagnosis, and treatment have changed the management and care of patients with this disease. The key to survival of colorectal cancer is screening and early detection. IMPLICATIONS FOR NURSING PRACTICE: Regardless of the multimodalities of treatment used, the nurse’s role as educator, caregiver, supporter, and advocate requires an ongoing commitment to remain knowledgeable of and current in advances made in the prevention, detection, and treatment of colorectal cancer.

 

 

AU:   Millat B, Borie F

AD:   Service de Chirurgie Digestive, Hopital Saint-Eloi, Montpellier.

TI:    [Is it necessary to monitor patients surgically treated for colorectal cancer?]

SO:   J Chir (Paris). 1998 Oct. 135(4). P 177-81.

AB:   Survival improvement in patients operated on for colorectal cancer might be the consequence of early diagnosis, rather than improvement in the treatment and follow-up. Therefore the question is: how to follow-up patients operated on for colorectal cancer? And even: is it necessary to follow-up these patients? Follow-up has two intentions, to diagnose metachronous tumors (adenomas and cancers), and to reveal a relapsing disease. However more than a relapse, diagnosis of a “residual” disease is questioned. This residual disease was present after what was thought to be a “curative” treatment, but lack of sensitivity of our diagnosis tools delayed the diagnosis. Follow-up is worthwhile if prognostic of patient treated of their “residual” disease is better when diagnosis is made during this follow-up, rather than when it is postponed until the disease become symptomatic. This has never been proved. Exams which should not be performed anymore are: CA 19-9, liver tests, systematic CT scan (as a diagnosis exam, but CT scan is worthwhile when a curative treatment is expected), systematic repeated colonoscopy. Conclusions on follow-up proposed at a recent consensus conference reached consensus in that it justified exams which effectiveness was never proved....

 

 

AU:   Herfarth C, Heuschen G, Heuschen UA

AD:   Chirurgische Klinik und Poliklinik, Universitat Heidelberg.

TI:    [Malignant transformation in ulcerative colitis and surgical implications]

SO:   Chirurg. 1998 Oct. 69(10). P 1020-7.

AB:   Patients with ulcerative colitis (UC) are at higher risk for cancer. Risk factors are duration of disease, extent of colitis, associated primary sclerosing cholangitis and possibly early onset of UC in childhood. Epithelial dysplasias are considered as precursors of colorectal cancer within the concept of an inflammation-dysplasia-carcinoma sequence. Dysplasia originates multifocally and is difficult to identify by colonoscopy. Histomorphological diagnosis can also be problematical. Surveillance programs utilize colonoscopy with random biopsies to diagnose dysplasia in patients with risk factors. The efficiency of these programs can be markedly increased when certain rules are applied. The ultimate aim must be to perform a proctocolectomy in patients at higher risk before invasive cancer develops. With only a few exceptions, colorectal cancer in UC can be treated by restorative proctocolectomy. Partial resection of the colon should be avoided because of the high frequency of occult carcinomas and multifocal carcinogenesis. There are first results that indicate a higher risk for malignant deterioration in the terminal ileum. After an ileoanal pouch procedure patients with chronic pouchitis seem to have a higher risk for dysplasia. At the moment the risk for malignancy cannot be calculated because of the relatively short follow-up time after ileoanal pouch procedures. However, it is recommended that after restorative proctocolectomy patients be followed by endoscopy and random biopsies for the rest of their lives.

 

 

AU:   Minardi AJ Jr, Sittig KM, Zibari GB, McDonald JC

AD:   Department of Surgery, Louisiana State University Medical Center-Shreveport, 71130, USA.

TI:    Colorectal cancer in the young patient.

SO:   Am Surg. 1998 Sep. 64(9). P 849-53.

AB:   Although predominantly a disease of older adults, colorectal cancer affects the younger population with an incidence of two to six per cent. It is thought to carry a less favorable prognosis in the young than in the general population. This may be due to advanced stage of the tumor at diagnosis. This study is composed of 37 patients, aged 40 and younger, treated over a 20-year period for colorectal cancer at Louisiana State University Medical Center-Shreveport and E. A. Conway Hospital. It was performed to investigate the incidence, stage at diagnosis, and prognosis of colorectal cancer in these young patients. The location of the primary tumor was fairly evenly distributed throughout the colon and rectum in this population. Pain, weight loss, rectal bleeding, and nausea and vomiting were the most common presenting symptoms. A family history of colon cancer or premalignant lesions were not risk factors in this study. Seventy per cent of all patients were treated with curative intent, and 42 per cent of these patients developed recurrent disease. The patients in this review presented with a higher incidence of advanced disease. Thirty-seven per cent of the lesions were Duke’s C and 22 per cent were Duke’s D, with poor 5-year survival (11% and 0%, respectively) when compared with national studies. The absolute 5-year survival for all young patients with colorectal cancer was 26 per cent (5 of 19 patients). It is important for the surgeon to be aware of the potential for colorectal cancer in young patients and to take an aggressive approach to the diagnosis and early treatment of the disease.

 

 

AU:   Parramore JB, Wei JP, Yeh KA

AD:   Department of Surgery, Medical College of Georgia, Augusta 30912, USA.

TI:    Colorectal cancer in patients under forty: presentation and outcome.

SO:   Am Surg. 1998 Jun. 64(6). P 563-7; discussion 567-8.

AB:   Colorectal cancer is the third most frequent malignancy in adults of both sexes in this country, with 90 per cent of patients diagnosed after age 50 years. This disease is unusual in patients under 40 years of age, and controversy persists as to prognosis in this subset of patients. Patients diagnosed with invasive adenocarcinoma of the colon and rectum from 1985 to 1997 were identified. They were then grouped according to age (< 40 or > or = 40). Charts were reviewed with respect to patient epidemiologic characteristics, clinical presentation, tumor staging, and survival. Twelve women and 24 men less than 40 years of age (median, 31 years/range, 13-39 years) were diagnosed with colorectal adenocarcinomas. This represented 8.6 per cent of the total patients diagnosed with colorectal cancers during this time. Thirty-five (97%) had symptoms (pain, blood per rectum, weight loss, or alteration in bowel habits) before diagnosis, and 23 (64%) had multiple symptoms. Younger patients had more poorly differentiated tumors (28%) and more mucinous adenocarcinomas (26%) than the older group. Younger patients were more likely to present with stage III or IV disease (78%) as well. Despite these findings, the median survival for younger patients was no different than the older patients when compared by stage. Colorectal cancer in young adults is rare, but should be considered in the differential diagnosis for all patients with gastrointestinal symptomatology. The presentation of these patients is not unlike that of older patients. Those patients with early-stage disease should be treated aggressively, as long-term survival may be anticipated, whereas the outcome for those with metastatic disease is poor.

 

 

Suicide Patterns and  Prevention

 

AU:   Isacsson G

AD:   Karolinska Institute, NEUROTEC, Division of Psychiatry, Huddinge Hospital, Sweden.

TI:    Suicide prevention—a medical breakthrough?

SO:   Acta Psychiatr Scand. 2000 Aug. 102(2). P 113-7.

AB:   OBJECTIVE: The author hypothesized, based on research until 1991, that a five-fold increase in the use of antidepressants might reduce Swedish suicide rates by 25%. A subsequent 3.5-fold increase in the use of antidepressants provided a ‘natural experimental situation’ for prospectively testing this hypothesis. METHOD: Swedish statistics on suicide, use of antidepressants, unemployment and alcohol consumption were obtained for 1978-96. Time-series of the latter variables were compared with suicide rates. Demographic subgroups regarding age, gender and county were analysed. Suicide rates were also compared with the use of antidepressants in Denmark, Norway and Finland. RESULTS: Suicide rates decreased in accordance with the a priori hypothesis. Alcohol consumption and unemployment rates did not correlate well with suicide rates. CONCLUSION: This naturalistic study is not conclusive. The increased use of antidepressants appears, however, to be one of the contributing factors to the decrease in the suicide rate. It is of great scientific and clinical importance that this be evaluated by further studies.RN: 0 - Antidepressive Agents; 0 - Serotonin Uptake Inhibitors

 

 

AU:   Mercy JA, Rosenberg ML

AD:   National Center for Injury Control and Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.      jam2@cdc.gov

TI:    Building a foundation for suicide prevention: the contributions of Jack C. Smith.

SO:   Am J Prev Med. 2000 Jul. 19(1 SUPPL). P 26-30.

AB:   Among his many other accomplishments, Jack C. Smith nurtured the early development of efforts by the Centers for Disease Control and Prevention (CDC) to address suicide as a public health problem. Smith’s vision was to achieve suicide prevention through epidemiology, and his vision shaped the emergence of suicide as a public health issue. With his typical enthusiasm and inherent ability to insinuate himself into critical social networks, Smith spearheaded CDC’s initial suicide surveillance activities and established strong partnerships between CDC and the National Institute of Mental Health (NIMH) and the American Association of Suicidology (AAS). These surveillance activities and relationships were the foundation on which subsequent research and programmatic activities addressing suicide as a public health problem were built at CDC.In this paper we document Smith’s role in the development of the public health approach to suicide prevention. We also articulate the conceptual basis for a public health approach to suicide and discuss future directions for public health in the prevention of suicide and suicidal behavior. While Smith also made important contributions to development of CDC efforts to address homicide, his special interest was suicide; therefore, this article will emphasize his contributions to this area.

 

 

AU:   Barrios LC, Everett SA, Simon TR, Brener ND

AD:   Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, USA. LIC8@cdc.gov

TI:    Suicide ideation among US college students. Associations with other injury risk behaviors

SO:   J Am Coll Health. 2000 Mar. 48(5). P 229-33.

AB:   Suicide, the endpoint of a continuum that begins with suicide ideation, is the third leading cause of death among the US college-aged population. The first and second leading causes of death among this age group, unintentional injury and homicide, may also be linked to suicide ideation. We used data from the National College Health Risk Behavior Survey to examine the association between suicide ideation and injury-related behaviors among 18- to 24-year-old college students. Students who reported suicide ideation were significantly more likely than students who did not report considering suicide to carry a weapon, engage in a physical fight, boat or swim after drinking alcohol, ride with a driver who had been drinking alcohol, drive after drinking alcohol, and rarely or never used seat belts. Given this clustering of injury-related risk behaviors, college prevention programs should aim to reduce risks for injuries comprehensively, rather than addressing each risk behavior separately.

 

 

AU:   Coppen A

AD:   MRC Neuropsychiatry Laboratory, West Park Hospital, Epsom, Surrey, UK.

TI:    Lithium in unipolar depression and the prevention of suicide.

SO:   J Clin Psychiatry. 2000. 61 Suppl 9P 52-6.

AB:   Unipolar depression is a severe recurrent illness with high lifetime morbidity and premature mortality due to suicide. Numerous double-blind, placebo-controlled trials have shown that lithium is very effective at reducing relapses when given as maintenance therapy. It is also very effective when given as maintenance therapy after electroconvulsive therapy. It can be given once a day at night, and controlled trials have shown a 12-hour plasma lithium level between 0.5 and 0.7 mmol/L the most effective, with very slight side effects. Long-term studies of lithium maintenance therapy show a suicide rate of 1.3 suicides per 1000 patient years. This is much lower than comparative studies in long-term follow-up of untreated depression, which show about 5.5 suicides per 1000 patient years. Although it is neither feasible nor ethical to carry out double-blind studies on suicide reduction, the massive evidence showing a reduction in morbidity on lithium treatment suggests that systematic long-term lithium treatment of unipolar depression could considerably lower the suicide rate.

 

 

AU:   Pirkola SP et al.

AD:   Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.

TI:    Suicides of alcohol misusers and non-misusers in a nationwide population.

SO:   Alcohol Alcohol. 2000 Jan. 35(1). P 70-5.

AB:   Alcohol dependence is a risk factor for suicide, and in the general population alcohol consumption and suicide rates are known to be associated. We investigated victims with and without alcohol misuse among unselected completed suicides to explore the role of alcohol misuse in the suicidal process and final act. In a total 1-year (1987-1988) population of suicides in the National Suicide Prevention Project in Finland, alcohol-misusing and -non-misusing victims were compared. On the basis of informant interviews, 35% (n = 349) of included victims were classified as alcohol misusers and 65% (n = 648) as non-misusers. The misusers were more often younger, male, divorced or separated and had more often worked, but were recently unemployed. They had experienced more often recent adverse life events possibly dependent on their own behaviour, were far more likely to be alcohol-intoxicated at the time of suicide, and tended to die from drug overdose. Several characteristics of these predominantly male alcohol misusers indicated better earlier lifetime psychosocial adjustment compared to the non-misusers, but more adverse life events close to suicide. Alcohol misuse is likely to have a deteriorating influence on the life course of those who eventually succumb to suicide, and its adverse consequences are common in misusers during the final months.

 

 

AU:   Hayes DN, Hemenway D

AD:   Department of Internal Medicine, Boston University School of Medicine, MA, USA.

TI:    Age-within-school-class and adolescent gun-carrying.

SO:   Pediatrics. 1999 May. 103(5). P e64.

AB:   BACKGROUND: Intentional injuries (suicide and homicide) are a leading causes of morbidity and mortality in the United States. Firearms cause approximately 70% of these fatal intentional injuries. Risk factors associated with gun-carrying in adolescent populations include male gender, smoking, alcohol use, drug use, and number of sexual partners. Current knowledge of these and other risk factors has provided limited benefit because many are no more obvious to the clinician a priori than is the tendency to carry guns. Increasing relative age of a student within school class is an easily measured parameter that has been associated with behavioral problems, absenteeism, negative self-image, and high dropout rates. OBJECTIVE: To characterize the association between relative student age-within-class and tendency to carry firearms. DESIGN: The Massachusetts Youth Risk Behavior Survey, which collects data on demographic characteristics, risk behaviors, and health outcomes. PARTICIPANTS: A randomly selected group of 3153 Massachusetts students in grades 9 through 11. PRIMARY OUTCOME MEASURE: The odds of firearms-carrying comparing older to average-age and younger students. RESULTS: Using multivariate logistic regression, seven risk factors predicted gun-carrying with statistically significant results: older age-within-class (OR: 2.12; 95% CI: 1.09-4.12), male gender (OR: 4.95; 95% CI: 3.01-8.15), black race (OR: 2.49; 95% CI: 1.20-5.14), gang membership (OR: 7.22; 95% CI: 4.51-11.56), missing school out of concern for safety (OR: 2.50; 95% CI: 1.30-4.80), seeking medical treatment after a fight (OR: 4.47; 95% CI: 2.56-7. 78), and fighting without seeking medical treatment (OR: 5.73; 95% CI: 3.09-10.60). CONCLUSION: Older 9th-, 10th-, and 11th-grade students are more likely than their classmates to carry firearms. This information may prove helpful in identifying high-risk students and targeting prevention strategies.

 

 

AU:   Neeleman J, Lewis G

AD:   Department of Social Psychiatry, University of Groningen, The Netherlands.

TI:    Suicide, religion, and socioeconomic conditions. An ecological study in 26 countries, 1990.

SO:   J Epidemiol Community Health. 1999 Apr. 53(4). P 204-10.

AB:   STUDY OBJECTIVE: Relative risks are frequently assumed to be stable across populations but this may not apply in psychiatric epidemiology where sociocultural context may modify them. Such ecological effect modification will give curved associations between aggregated risk factor and outcome. This was examined in connection with the ecological association between suicide rates and an aggregate index of religiosity. DESIGN: Ecological study of associations between suicide rates and an index of religiosity, adjusted for socioeconomic variation. The effect of stratification of the study sample according to levels of religiosity, was examined. SETTING: 26 European and American countries. SUBJECTS: Interview data from 37,688 people aggregated by country. OUTCOME MEASURES: Age and sex specific (1986-1990) suicide rates. MAIN RESULT: Adjusted for socioeconomic variation, negative associations of male suicide rates with religiosity were apparent in the 13 least religious countries only (test for interaction F (1, 25) = 5.6; p = 0.026). Associations between religiosity and female suicide rates did not vary across countries. CONCLUSION: The bent ecological association was apparent only after adjustment for socioeconomic variation suggesting that, rather than confounding, ecological modification of individual level links between religion and male (but not female) suicide risk is the responsible mechanism. This concurs with micro-level findings suggesting that suicide acceptance depends not only on personal but also on contextual levels of religious belief, and that men are more sensitive to this phenomenon than women. In psychiatric epidemiology, relative risks vary with the exposure’s prevalence. This has important implications for research and prevention.

 

 

AU:   Mishara BL, Daigle MS

AD:   Center for Research and Intervention on Suicide and Euthanasia, Universite du Quebec a Montreal, Canada.

TI:    Effects of different telephone intervention styles with suicidal callers at two suicide prevention centers: an empirical investigation.

AB:   To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of “Rogerian” nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.

 

 

AU:   Baume P, Rolfe A, Clinton M

AD:   Central Sydney Area Health Service, New South Wales, Australia. baumep@rpamail.cs.nsw.gov.au

TI:    Suicide on the Internet: a focus for nursing intervention?

SO:   Aust N Z J Ment Health Nurs. 1998 Dec. 7(4). P 134-41.

AB:   The Internet is a means for people who do not know each other to share information to their mutual benefit or harm. Whereas electronic communication without censorship has its benefits, the net has not escaped the attention of people contemplating suicide. If mental health nurses are to assist vulnerable people who surf the net in search of encouragement to complete suicide, they need to know about Internet resources on suicide and to understand how suicide fatalities influence the behaviours of vulnerable people who express suicidal ideation in cyberspace. The importance of suicide modelling, ambivalence, group death wishes, suicide notes and related research is considered. Mental health nurses are invited to consider the implications for suicide prevention.

 

 

AU:   Claussen B

AD:   Institute of General Practice and Community Medicine, Department of Social Insurance Medicine, University of Oslo, Norway.

TI:    Suicidal ideation among the long-term unemployed: a 5-year follow-up.

SO:   Acta Psychiatr Scand. 1998 Dec. 98(6). P 480-6.

AB:   Suicidal ideation was monitored in a 5-year follow-up of a representative sample of long-term unemployed Norwegians. Four items from the General Health Questionnaire-28 were used as a Suicidal Ideation Index, which showed a prevalence of 17% in the present sample of unemployed subjects, higher than the value of 11% in a sample of Australian students used to construct the Index. Five years later, suicidal ideation was found in 6% of those who had been re-employed and 22% of those still unemployed, indicating that the high prevalence of suicidal ideation may be due to unemployment. Routine clinical examination was also tried for preventive purposes. In total, 8% of the unemployed subjects showed clinically significant suicidal ideation. They were referred to a psychologist or their GP, and were given the standard advice about suicide prevention. A Resource Centre, which many employees at the Labour Office have missed, has now been set up in the area under the National Plan for Suicide Prevention.

 

 

AU:   Haste F, Charlton J, Jenkins R

AD:   Barking and Havering Health Authority.

TI:    Potential for suicide prevention in primary care? An analysis of factors associated with suicide.

SO:   Br J Gen Pract. 1998 Nov. 48(436). P 1759-63.

AB:   BACKGROUND: General practitioners (GPs) need to be aware of the risk factors for suicide. GP records may provide clues to identifying the relative importance of such risk factors. AIMS: To identify, in suicide cases and matched controls, the patterns of consultation, diagnosis, and treatment of mental illness, and recording of risk factors for suicide. To examine the usefulness of data routinely collected by GPs in computerized databases to investigate treatment of patients in general practice prior to suicide. METHOD: Case control study using GP records from the General Practice Research Database (GPRD). Three controls selected for each case, matched for age, sex, and duration of registration with practice. Information extracted of the prevalence of major disease; diagnosis of, and treatment, or referral for, mental illness; frequency of recording of recent life events; and consultations with the GP in the 12 months prior to death. RESULT: Of the 339 suicide cases recorded, 80% were male, which is similar to the national percentage for this age group. Females were more likely than males to have a history of mental illness and to have been diagnosed and treated for mental illness in the 12 months before death (59% versus 35%), and women were more likely to have previously attempted suicide (47% versus 27%). There was no significant difference between males and females in period of time since last contact with GP practice, but females consulted more frequently. Twenty-nine per cent of cases had not consulted their GP in the six months prior to death. In multivariate analysis, the following were identified as independent risk factors: history of attempted suicide; untreated serious mental illness (odds ratio > 20); recent (past 12 months) marital life event; alcohol abuse; frequent consultations with GP; and previous mental illness. Recording of life events by GPs was poor. CONCLUSIONS: Females at risk of suicide are more likely than males to have been diagnosed and treated for mental illness. It is likely that GPs are under-diagnosed and under-treating males at risk. Data from the GPRD give comparable results to those from other studies. The GPRD is a potentially useful tool for research into relatively uncommon events in general practice.

 

 

Завършени проекти

 

Повишаване степента на удовлетвореност сред наставници и стажанти от специалността “Здравни грижи” от преддипломия стаж по педагогика

 

Макрета Драганова

 

     Държавният преддипломен стаж по педагогика е важен етап от цялостната подготовка на студентите-бакалаври от специалността “Здравни грижи”. Той има за задача да провери и усъвършенствува изградените по време на обучението практически умения и да приложи в условията на реалната практика придобитите теоретични знания. За добрата организация и ефективното провеждане на стажа решаващо значение имат личното отношение и професионалното участие на наставниците от приемащите колежи.

     В  началния етап на проекта Ръководството на Медицински колеж - Плевен и специалност “Здравни грижи”, се запознаха с целите и същността на проекта. Проведоха се две анкетни проучвания /според времевия план на проекта/.

     1. Анкетно проучване на мнението на наставниците.

     Проведената анкета цели да проучи мнението на наставниците от Медицински колеж - Плевен, участвали в преддипломния стаж по педагогика относно организацията и протичането на стажа с първия випуск студенти през септември-октомври 1998г. От общо 16 наставника при провеждането на анкетата са се отзовали 11, което прави 68,75%.

     Анкетата включва седем въпроса, касаещи организацията и провеждането на стажа, теоретичната подготовка на студентите, както и практическите им умения. Осмият въпрос, който дава възможност в свободна форма да се изразят забележки и препоръки и който касае проекта дава информация, че е необходимо непосредствено преди стажа, преподавателите - наставници, да се запознаят с изискванията към тях. Дадени са и други препоръки, които нямат пряко отношение към разглеждания проблем.

     2. Анкетно проучване мнението на студентите - стажанти.

     Проведеното анкетно проучване имаше за цел  да установи как студентите оценяват организацията и провеждането на стажа. То проучи и взаимоотношенията с наставниците и педагогическия колектив, поради уникалния характер на обучението и липсата на опит в провеждането на преддипломен стаж.

     От общо 47 студенти, при провеждането на анкетата се отзоваха 47, т.е.100%.

     Анкетата включва осем въпроса, касаещи организацията, провеждането и заключителната фаза на стажа, реализирана като практически изпит и един въпрос, даващ възможност в свободна форма да се изразят забележки и препоръки, касаещи преддипломния стаж. Осмият въпрос от анкетата е “Считате ли, че организирането на курсове за наставници, по актуални проблеми  по педагогика, ще подобри практическата подготовка по време на преддипломния стаж?”. Съотношението на отговорите на този въпрос е:

     Високият процент на отговорилите  с “ДА” на въпроса, потвърждава необходимостта от провеждане на курсове с наставниците.

 

     За учебната 1999/2000 година преддипломният педагогически стаж на студентите - V - ти семестър, стартира на 4.10.1999г. и  приключи на 3.ХІІ.1999 г. Общият брой на студентите е 56, разпределени в три стажантски групи. Стажът се провежда в МК - Плевен, МК - Стара Загора, МК - Велико Търново.

     По реализирането на проекта бяха осъществени следните дейности:

     1. Проучено бе мнението на наставниците с цел установяване  на техните професионални интереси и вълнуващи ги педагогически теми и проблеми. В заключение се оформиха следните предпочитани теми:

*   Общуването  в педагогическата  дейност.

*   Иновации в медицинската педагогика.

     2. Поканена бе за гост - преподавател гл. асистент Вили Нишева от МУ -  София, Катедра “Социална медицина и обществено здравеопазване”, Секция “Педагогика”.

     3. На 4.10.1999г. бе проведен еднодневен курс на тема “Общуването в педагогическата дейност.” В курса участваха 10 наставника, включени в тазгодишния преддипломен педагогически стаж. На участниците бяха предоставени тестове, касаещи уменията им за слушане, уменията им да казват “не”, уменията им да се разпореждат, уменията им да говорят добре и др., в резултат на което всеки направи самооценка, а в заключение  се оформиха две групи личностни качества:

1. Личностни качества, които подпомагат общуването в учебния процес.

2. Качества, които са противопоказани за педагогическата дейност.

Непосредствено след курса се проведе анкета с участниците в него с цел установяване удовлетвореността им. На въпроса “Считате ли, че проведения курс на тема “Общуването в педагогическата дейност” е полезен за работата Ви по време на преддипломния стаж по “Педагогика”?, всички анкетирани отговарят с положителен отговор /100% - да/. На анкетираните преподаватели бе предоставена и възможност  да посочат какво друго би подпомогнало съвместната им дейност със стажантите от специалност “Здравни грижи” по време на Държавния педагогически стаж. Съотношението на от говорите на този въпрос е:

     В отовор “Други” 8 /80%/ от анкетираните отбелязват в свободен текст, че за по-ползотворна съвместна дейност, добре би било  да се предостави материал, включващ избрани методически разработки, изработени от стажанти по време на Държавен педагогически стаж от предходни години.

Имайки предвид резултатите от това анкетно проучване и основната цел на проекта,  а именно “Да се повиши удовлетвореността от съвместната работа между наставници и стажанти по време на преддипломния педагогически стаж,  по реализирането на проекта бяха осъществени следните дейности:

1. Изготвен бе “Сборник с методически разработки на студентите от Първи випуск - 1998г. и бе предоставен на наставниците, включени в тазгодишния Преддипломен педагогически стаж, които са общо 26, разпределени както следва: МК-Варна - 7 наставника, МК-Плевен- 15 и МК-В.Търново - 4.

     2. Предстои издаването на материал “Основни принципи на сестринството”, който е превод на труда на Вирджиния Хендерсон под същото заглавие. Материалът е в почти завършен стадий и се очаква получаване на copyright от International Council of Nurses, откъдето ни беше предоставено и оригиналното заглавие. Това издание ще подпомогне твърде много преподавателите по практика, които работят от три години по нови учебни програми. Същият ще може да се ползва и от самите студенти-колежани и студентите от специалността “Здравни грижи”.

     3. За учебната 2000/2001г. преддипломния педагогически стаж на студентите - V - семестър,  стартира на 2.10.2000г. и трябва да приключи  на 20.ХІІ.2000г. Общият брой на студентите е 64, разпределени в четири стажантски групи. До настоящият момент е приключил стажа на Първа група - 16 стажанти, които са анкетирани. На въпроса “Как преценявате сътрудничеството между Вас и наставника?”, който има пряко отношение  към същността на проекта, отговорите са в следното съотношение:

     Отговорите на същия въпрос, получени в началото на проекта, с цел установяване на изходното положение, изглеждат по следния начин:

     От така представените резултати, се вижда че относителният дял при отговор 3, който е оптималното към което  се стремим се е повишил с 28,2%. Това ни дава основание да считаме, че на този етап целта на проекта е изпълнена.

     3. С цел окончателното реализиране на проекта,  се  предвижда анкетиране  на  наставници и студенти след приключване на тазгодишния преддипломен педагогически стаж - 20.12.2000г.

 

 

Подобряване качеството на преддипломния стаж по “Управление на здравните грижи”, чрез периодични тридневни курсове за старши сестри – наставници

 

Мариела Камбурова

 

     Държавният преддипломен стаж по Управление на здравните грижи е важен етап от цялостната подготовка на студентите-бакалаври от специалността “Здравни грижи”. Той има за задача да провери и усъвършенствува изградените по време на обучението практически умения и да приложи в условията на реалната практика придобитите теоретични знания. За добрата организация и ефективното провеждане на стажа решаващо значение имат личното отношение и профе-сионалното участие на наставниците от приемащите стажантите клинични звена.

     В  началния етап на проекта, Ръководството на ВМИ - Плевен и специалност “Здравни грижи”, се запознаха с целите и същността на проекта. Проведоха се две анкетни проучвания  /според времевия план на проекта/.

     1. Анкетно проучване на мнението на наставниците.

     Проведената анкета целеше да проучи мнението на пара-медицинските кадри/ наставниците от ВМИ - Плевен, участвали в преддипломния стаж по Управление на здравните грижи относно организацията и протичането на стажа с първия випуск студенти през септември-октомври 1998г. От общо 31 наставника при провеждането на анкетата са се отзовали 22.

     Анкетата включва седем въпроса, касаещи организацията и провеждането на стажа, теоретичната подготовка на студентите, както и практическите им умения. Осмият въпрос, който дава възможност в свободна форма да се изразят забележки и препоръки и който касае проекта дава информация, че е необходимо непосредствено преди стажа, преподавателите - наставници, да се запознаят с изискванията към тях.

     2. Анкетно проучване на мнението на студентите - стажанти.

     Проведеното анкетно проучване имаше за цел  да установи как студентите оценяват организацията и провеждането на стажа. То проучи и взаимоотношенията им с наставниците и колективите в клиничните звена на ВМИ, поради уникалния характер на обучението и липсата на опит в провеждането на преддипломен стаж.

     От общо 47 студенти, при провеждането на анкетата се отзоваха 47, т.е.100%.

Анкетата включва осем въпроса, касаещи организацията, провеждането и заключителната фаза на стажа, реализирана като практически изпит и един въпрос, даващ възможност в свободна форма да се изразят забележки и препоръки, касаещи преддипломния стаж. Осмият въпрос от анкетата е “Считате ли, че организирането на курсове за наставници, по актуални проблеми  по Управление на здравните грижи, ще подобри практическата подготовка по време на преддипломния стаж?”. Съотношението на отговорите на този въпрос е:

 

     Високият процент на отговорилите  с “ДА” на въпроса, потвърждава необходимостта от провеждане на курсове с наставниците.

На 20.11.1999г., 23.11.1999г. и 30.11.1999г., в специалност “Здравни грижи” при ВМИ - Плевен, се проведе курс за ръководни кадри на тема “Управление на материалните ресурси”.

Идеята за провеждане на курсa беше представена и обсъдена на работна среща на главната сестра, при ИБ - Плевен Румяна Кирчева, и старшите сестри от същата болница. В хода на оживената дискусия се избистри необходимостта и желанието на ръководните сестрински кадри да се включат в подобни курсове.

Своевременно беше представена темата на първия курс и програмата за провеждането му. Във връзка с повишения интерес към курса, беше предоставена възможност в него да се включат и дипломирали се в специалност “Здравни грижи” бакалаври.

На 23.11.1999г. се проведе първият модул от теоретични и практически занятия /8 учебни часа/. В него преподаватели бяха изтъкнати специалисти  по “Икономика на здравеопазването”, а именно доц. Евгения Делчева и доц. д-р Стефан Гладилов. Те запознаха курсистите с основни понятия и новости във финансовия мениджмънт и бюджетирането на сестринските грижи. Проведе се дискусия, на която отговор намериха актуални за курсистите въпроси.

Доц. Гена Грънчарова разгледа корективна 6 стъпкова програма за разрешаване на проблеми във връзка с ефективното контролиране на използването на материалите.

На 23.11.1999г. се проведе вторият блок от 8 учебни часа теоретико-практически занятия. Инж. Румен Русев представи актуална статическа информация и обсъди с курсистите въпроси касаещи планирането и контрола на материалните ресурси в сестринството в ИБ - Плевен. Бяха проведени практически занятия, на които чрез дискусия и  провеждане сред курсистите на брейнсторм се отчетоха причините, водещи до неефективно използване на материалните ресурси в ИБ - Плевен.

На 30.11.1999г. на практическите занятия се представиха приложими в сестринството методи за подобряване ценовата ефективност в работата.  Обсъдиха се проблемите за мотивацията и стимулирането на персонала, чиято липса е една от основните причини за неефективна работа на медицинските специалисти.

Курсистите представиха и защитиха индивидуални практически разработки по темата на курса, приложими в ръководеното от тях клинично звено, които породиха оживени дискусии.

На всички участници в курса беше предоставен материал, адаптиран превод на  доц. Гена Грънчарова по разгледаната тема.

Участниците в курса бяха анкетирани с цел проучване на удовлетвореността им от организацията и провеждането му. Те предложиха теми за бъдещи курсове, касаещи управлението на здравните грижи.

Курсът приключи с издаване на персонални удостоверения на всеки участник.

Една от темите, които старшите сестри предложиха, беше обект на разглеждане по време на втория курс, а именно “Ефективно управление на времето”. Курсът се проведе през месец май по същата схема както първия. Той протече под формата на теоретични и практични занятия със старши сестри - наставници по Управление на здравните грижи.

В рамките на 10 часа теоретични занятия доц. Гена Грънчарова разгледа актуалната тема с помощта на собствен, адаптиран превод. На базата на разгледания материал, бяха проведени практическите занятия от асистентите в специалност “Здравни грижи”. Те протекоха под формата на дискусия по разглежданата тема; самооценка на участниците по отношение собственото им виждане по проблема и готовността им да изберат подходяща стратегия за решаването му.

На всички участници беше предоставен материал, адаптиран превод на доц. Грънчарова по разгледаната тема.

В дискусия и неформални разговори участниците споделиха удовлетвореността си от поведения курс.

 

Дейности реализирани по проекта:

1. Анкетиране на студенти и наставници - октомври 1998 г.

2. Провеждане на курс “Ефективно контролиране на използването на материалите” - ноември1999 г.

3. Провеждане на курс “Ефективно управление на времето” - май 2000 г.

4. Изработване и предоставяне на участниците в курсовете 2 материала, адаптирани преводи на доц. Гена Грънчарова - след приключването на всеки курс.

5. Анкетиране на студенти - октомври 2000 г.

 

 

Completed projects

Increasing the level of satisfaction with pre-graduation teaching practice among tutor nurses and trainee nurses at the Pleven Faculty of Nursing

 

Mrs. Makreta Draganova

 

Pre-graduation teaching practice is an important part of the training program for students of the Faculty of Nursing.

The aim of the project was to increase the level of satisfaction of both tutors and trainee nurses by 20%, as compared to previous year.

The inquiry carried out to assess the existing level of satisfaction showed that  62.5%  of the tutors, and 74.46% of the trainees were satisfied with the practice. The inquiry was also aimed to find out what topics they are interested in professionally, and in the field of teaching methods.

A one-day course in communication strategies was organized and assessed.

A selection of papers prepared by trainees (1998) was compiled and placed at the disposal of 26 tutors of nursing colleges (Varna – 7 tutors,  Pleven – 15 tutors, and Veliko Turnovo – 4 tutors). A new book on nursing care is being translated by Assoc. Prof. G. Grancharova, , and will be distributed to the nursing colleges.

In December 2000, a final inquiry was carried out. results showed that 83.33%   of the tutors, and 78.13% of the trainees were satisfied with the pre-graduate training practice.

 

 

Improving the quality of pre-graduate practice in nursing care management at the Pleven Faculty of Nursing in Pleven

 

Dr. Mariela Kambourova

 

Pre-graduate practice in nursing care management is an important part of the training for nurses at the Faculty of Nursing. The attitude and professionalism of tutor nurses is of utmost importance for the organization and effectiveness of the process of training.

The project aimed to improve the training process and the level of satisfaction among trainees by 25% over a period of one year, by organizing courses for tutor nurses.

In October, an inquiry showed that 50% of the nurses and tutors were satisfied with the way the courses were organized and carried out.

Two training courses were organized for tutors: “Effective control of use of consumables” (November,1999), and “Effective management of working time” (May, 2000).

     Sets of materials on the topics translated and adapted by Assoc. Prof. Grancharova were provided for the participants of each course.

     Of all students, 80% were satisfied by the pre-graduate course (inquiry carried out in December, 2000). At the state examination, 90% of the students showed excellent results.

 

 

Действащи проекти / PROJECTS  IN ACTION

 

Програма за промоция на здравето сред работещите в ЕООД “Тролейбусен транспорт” - Плевен

 

Мариана Михайлова

 

     Програмата стартира м.май 2000 г. с подробен анализ и оценка на груповото здраве на работещите лица. С анализа бе запознато ръководството на фирмата и информирано относно целта на програмата. От ХЕИ - Плевен набавихме листовки, свързани с промоцията на здравето и бяха поставени на достъпни места за ползването им. Започна измерване на кръвната захар на лицата с установен диабет, както и на фамилно обременените. Бяха отпечатани и разпространени два вида листовки. На на желаещите бе поставена противогрипна ваксина.

Ежедневно се проследява артериалното налягане на регистрираните хипертоници и при нужда се коригира терапията. При всяко новооткрито заболяване се провеждат индивидуални разговори с пациентите, дават им се подробни указания за режим, диета, възможни усложнения и поведението при тях.

     Резултатите от работата по проекта се отчитат периодично. Създадена е база данни за текущо отчитане на резултатите от работата по проекта.

    

 

Психологична подкрепа на болните с новооткрити онкологични заболявания

 

Иванка Иванова

 

     Изготвени са брошури с цел повишаване информираността на пациентите, анкетна карта и въпросници. Раздадени са допълнително здравно-просветни брошури с любезното съдействие на фондация “Борба с рака” за основните локализации към съответните кабинети.

     Работи се по съставянето на компютърна програма, проследяваща група от 100 новодиагностицирани болни.

 

 

Здравно-образователна програма сред 50 хипертоници /50-70 години/ в с. Рибен за профилактика на МСБ

 

Силвия Пенева

 

     Подготвиха се и се разпространиха покани и анкетни карти за 50 хипертоника. Изнесена е радиобеседа на тема “Нелекуваната хипертония - предпоставка за мозъчно-съдови заболявания”.

За пациентите включени в целевата група бяха отпечатани и разпространени дневници за самоконтрол. Изготвено е табло. Предстои издаване на брошура “За да се предпазим от мозъчно-съдови заболявания, трябва да поставим кръвното си под контрол”.

На всички участници в проекта два пъти месечно се мери профилактично кръвното налягане без потребителска такса.

 

    

Споразумение между ОПЛ, завеждащите на отделенията, сестрите и лабораторните екипи във връзка с рационалното използване на реактивите за биохимични изследвания

 

Антоанета Лукановска

 

     Проведена бе дискусия по рационалното използване на реактивите в лабораторията, както и индивидуални разговори със семейните лекари, завеждащите на отделенията и старшите сестри.

Идеята бе добре възприета от повечето от лекарите и лабораторния екип. Биохимичните изследвания са намалели с 4,35% за четиримесечен период за старта на проекта, т.е. от м. юни 2000 г.

     Предстои да продължи работата по посока намаляване на разходите и възможно най-рационално използване на реактивите за биохимични изследвания с цел доближаване до заложеното в проспекта 10% намаление на ненужните изследвания.

 

 

Профилактика на гръбначните изкривявания при учениците от І-ви клас при училище “Максим Горки” в гр. Левски

 

Кичка Симеонова

 

     С целите на проекта бяха запознати директорът на училището и  учителките на І-ви клас /общо 64 деца/, както и родителите на децата.

Извършен бе профилактичен преглед от ортопед, при който бяха открити 8 деца с неправилна стойка, едно с лумбална сколиоза и едно с торакална сколиоза първа степен. На три от децата се направиха рентгенови снимки.

     Отпечатани и раздадени са брошури, съдържащи комплекс профилактични упражнения на двете учителки, на осемте деца с неправилна стойка и две брошури за децата със сколиоза – комплекс упражнения за І-ва степен гръбначни изкривявания, градус 5.

     Закупени са уреди за изправителната гимнастика. Всички деца провеждат изправителните упражнения в училище три пъти седмично, а тези с проблеми - и вкъщи с родителите си.

 

 

Образователна програма за профилактика на фебрилните гърчови състояния при децата до 2 г. в региона на гр. Враца

 

Цветелина Иванова

 

     Проведена е среща с ръководството на отделение “Новородени” при многопрофилна болница за активно лечение в гр. Враца за запознаване с проекта, неговите цели и привличане на съмишленици.

Изготвени са листовки “Как да предпазим децата от температурен гърч”, които старшата медицинска сестра раздава на майките на всички новородени в отделението.

     Предстои закупуване на термометри за социално слаби деца, родени след стартирането на проекта. Първите рузултати ще се отчетат след 6 месеца.

 

 

Здравно-възпитателна програма за повишаване на сексуалната култура сред учениците от Х-ти клас на СОУ “Емилиян Станев” в град Велико Търново

 

Стелка Коева

 

     В екипа на проекта се включиха г-н Казаков - директор на училището, г-жа Ганева - специалист от ХЕИ, г-жа Цанева – психолог на СОУ, д-р В. Хаджирадев, д-р Ангелов, д-р Богданов.

     Проектът обхваща 160 ученици. За период от 3 месеца по един път седмично в часа на класния ръководител се провеждат беседи с времетраене 30 минути, като се започне през месец декември 2000 г. с една тема, а останалите 9 теми са предвидени за януари, февруари и март 2001 г. Всяка тема е разработена и представена от лектор- експерт. Включени са различни специалисти: акушер-гинеколог, психиатър, специалист по кожно-венерически болести, психолог. При някои от темите за СПИН, наркотиците, контрацепция, сифилис е предоставен видеоматериал и подходящи брошури от специалисти на ХЕИ безплатно. Беседите по някои от темите включват и видеоматериали.

     Екипът на програмата осигури видеоматериала и брошури, анкета, материално-техническата база, залата и тематичния план по дати и часове, съобразно училищната програма, подходящи за възрастта лекции.

     Търси се съдействие от Великотърновския университет и други организации.

 

 

Здравно-просветна програма сред диспансеризираните хипертоници в една лекарска практика в гр. Каспичан с цел нормализиране на стойностите на артериалното налягане при 30% от тях

 

Милена Недева 

 

     Лекарската практика обхваща 2 272 души. До момента 178 от тях са диспансеризирани за ХБ. От тях само ХБ - 47, всички останали са с по 2 до 4 заболявания - ИБС, МСБ, захарен диабет и др.

За включените в програмата е изчислен индекс на телесно тегло /38% с наднормено тегло, а 19% - със затлъстяване/, изследвано е и нивото на холестерола /от 26 изследвани, 20 с холестерол над 5.2 mmol/. Сред диспанзеризираните бяха открити четири случая на диабет и два с пиелонефрит.

Проведената с диспансеризираните 178 души анкета установи, че голяма част от тях имат нужда от подобна здравнообразователна програма.

     Два пъти седмично работим с тези пациенти - измерване на КН, на теглото, разясняване на здравословния начин на живот и рисковите фактори.

     Заедно с анкетата на всеки пациент се дава лист с препоръчителните храни и със здравни съвети.

     Съдействие получих от фирма “Фаянс”, гр. Каспичан да ползвам техния здравен кабинет в удобно за мен и за работещите там бреме.

 

    

Програма за обучение на диспансеризираните болни с хепатит “В” и “С” в Гастроентерологичен кабинет за лечение с интерферон в домашни условия

 

Мая Пелкова

 

     Изработени и отпечатани два вида листовки: “Какво знаем за хепатит “С”и “Въпроси и отговори за хепатит “В”, които се дават на пациентите, посетили кабинета за диспансеризация на хроничните вирусни хепатити при МБАЛ - Плевен.

     Изработена и отпечатана “Диспансерна карта” за болните, които провеждат лечение с Интерферон /Роферон - А/. Дават се на всички болни, изписани от стационара. Служи за информиране на личния им лекар за провежданото лечение, дозировка на препарата и какви контролни изследвания трябва да имат за ежемесечните контролни прегледи в кабинета.

     Осъществени са индивидуални срещи с всички нови пациенти, постъпващи за лечение с Роферон. На всички нови пациенти, постъпили за лечение с Роферон им е показана техниката на поставяне на медикамента подкожно. Ежедневно са контролирани доколко са усвоили манипулацията.

     Работата по проекта не е срещнала трудности и продължава. Предстои междинно и крайно отчитане на резултатите, т.е. изчисляване на средния престой на болен в клиниката и анкетиране на пациентите.

 

 

Намаляване честотата на зъбен кариес сред 150 деца на възраст 6 - 10 год. от СОУ “Хр. Смирненски” - гр. Искър чрез медикаментозна флуорна профилактика и обучение в поддържане на добра устна хигиена

 

Яна Глоговска

 

     С целите на проекта беше запознат директорът на училището и родителите на децата.  Направен бе и анализ за флуорно съдържание на питейната вода. През месец октомври  започна и  флуорната профилактика едновременно с обучение на децата: инструктаж за правилно миене на зъбите и беседа “10 правила да имаш здрави зъби и венци”. Подготвена е и здравна брошура “Заедно да победим кариеса”.

     В реализирането на проекта се включиха родители, директорът на училището г-н Лаловски, класните ръководители, а същи така и преподавателят по информатика г-н Тончев.

 “Арома” – София подкрепи проекта с четки и пасти за зъби. Търсят се възможности и за финансова подкрепа от общината.

 

 

Повишаване информираността на жените, посещаващи АГ кабинет – Русе относно хламидиалната инфекция

 

Пламена Полихронова

 

     Изготвени са брошури – листовки с помощта на фармацевтична компания “Вивилон”, разпространени в някои кабинети по обща практика.

     Предстои изготвяне на плакати, анкетни карти, предоставяне на плакати и брошури в училищата и останалите кабинети по обща практика.

 

 

Откриване на кът за забавно-възпитателна работа с децата на Детско отделение при Обединена болница “Св. Иван Рилски” – гр. Козлодуй

 

Даниела Николова

 

     Осигурено помещение, отремонтирано от спонсори. Обзаведено е с маси и столчета.

     Предстои обзавеждане на помещението.

 

 

Обучение на студентите от МК – Плевен за безопасна работа по време на учебна практика в клиничната лаборатория

 

Иванка Стойкова

 

     Запознаване на ръководството и колектива на МК с програмата. Изработване на брошури  с указания за безопасна работа с кръв, урина и химикали.

     Проектът стартира през септември 2000 г.

 

 

Повишаване броя на обучените по сестрински метод медицински сестри – наставници, работещи в Детска клиника при Висш медицински институт – гр. Плевен

 

Анка Христова

 

     С проекта е запознат директора на Медицински колеж и преподавателите, завеждащия Детска клиника и старшата медицинска сестра.

Изготвена е анкетна карта за медицинските сестри – наставници.

     Предстои да се проведе анкетата и курсът с наставниците. Продължителността му ще бъде 6 седмици по 2 часа седмично.

     Проектът ще приключи през юни 2001 г.

 

 

Здравно-възпитателна програма за профилактика на затлъстяванията чрез рационално хранене и активен двигателен живот сред учениците на СОУ “Христо Ботев” - гр. Никопол

 

Вероника Владимирова

 

     Проектът стартира от 15.09. 2000 г. и ще завърши през м. юни 2002 г.

     Проектът беше обсъден  със завеждащ отдел “Просвета” на община Никопол,  с директора и учителски колектив.

     Изготвена е брошура  “Как да победим излишните килограми” за децата и програма за тематичните единици.. Предстои да се изработи брошура и за родителя.

 

 

Програма, насочена към шофьорите, работещи в ЦСМП - гр.Плевен за оказване на първа помощ при пътно-транспортно произшествие

 

Виолета Василева

 

     Сформиран е екип и е подбрана целевата група.

     Екипът разработи учебна програма, отпечатани са  два вида листовки и анкетна карта.

     Работата по проекта през месец  юни 2000 и ще завърши през юни 2001 г.

 

 

Профилактична програма за борба с нерационалното хранене и тютюнопушене сред хипертониците от еднолична медицинска практика в с. Староселци, Плевенско за срок от 2 години.

 

Снежана Богданова

 

     Проведени за две срещи с диспансеризираните лица – през месец август и месец октомври. През септември е проведена радиолектория.

Периодично ще се проверяват  КК, серумен холестерол и телесно тегло.

 

 

Ефективно контролиране на използването на консумативите, обхващаща полувисш  персонал на Приемно отделение - гр. Русе

 

Анжела Щраус - Колева

 

     Проведена е дискусия по проблема. Изготвено е табло и колективът е запознат с цената на консумативите. Изготвен е фиш за изразходваните консумативи, улесняващ контрола и рационалното им използване.

Целта на проекта е снижаване на разходите с 10%.

 

 

Осигуряване на пълноценно хранене на 20 - 30 деца от 0 - 3 години, живеещи при лоши социално-битови условия и ниски доходи чрез предоставяне на безплатна храна

 

Венцислава Георгиева

 

     С целите на проекта е запознато ръководството на млечната кухня - медицинския директор, главната сестра, главния счетоводител.  Съставен е списък на 20 деца, отговарящи на определени условия.

Започна кампания за набиране на финансови средства.

 

 

Health promotion for employees of a trolley-bus company in Pleven

 

Mrs. Mariana Michailova

 

Assessment of all employees was made, and the results were analyzed and presented to management. Health education materials were provided. Blood sugar levels are regularly checked in diabetics and in those with a family history. Arterial pressure is checked every day in workers diagnosed, and therapy is changed if necessary. All employees with newly registered conditions are instructed as to the daily regimen and diet, possible complications and patterns of behavior should such complications occur. Anti-flue vaccines were provided for those willing to be vaccinated.

Changes in the health status are registered and analyzed regularly. A database has been made, which will allow to find correlation between the activities for active follow-up and health promotion, and the number of days off because of temporary incapacity for work.

    

 

Psychological support for newly diagnosed cancer patients at the Center of Oncology in Pleven

 

Mrs. Ivanka Ivanova

 

     Brochures, questionnaires and leaflets were prepared to increase the level of information among these patients. Each consulting room offers such materials to their patients. The team of the center has provided some of the brochures with the assistance of the “Struggle against Cancer “ foundation – Sofia.

A computer program is being prepared for follow-up of one hundred newly diagnosed patients.

 

Health education program for 50 hypertensive patients in the village of Riben to prevent cerebrovascular disease

 

Mrs. Silvia Peneva

 

     Fifty  people with hypertension were invited to participate in the program. A brochure and a poster were prepared, and a radio talk on hypertension and the risk of cerebrovascular disease.

     All patients were provided with diaries for self-control and observation. Twice a month, they all turn up for check ups free of charge.

    

Cost-effective use of reagents in biochemical tests

 

Mrs. Antoaneta Loukanovska

 

     A discussion was organized at the laboratory in Byala Slatina with laboratory staff, as well as GPs, heads of departments and senior nurses, aimed to persuade them to avoid prescribing biochemical tests unnecessarily.

     For four months, the expenses for reagents for biochemical tests were reduced by 4.35%. A reduction by 10% is expected by the time the project is completed.

 

Prevention and correction of spinal deformities in children aged 7-8 in Levski

 

Mrs. Kitcka Simeonova

 

     A check up was carried out for 64 children. The orthopedic surgeon diagnosed 8 children with incorrect posture, one – with lumbar scoliosis, and one – with thoracic scoliosis.

     The project plan was presented to the school authorities, class teachers and the parents.

     Brochures were prepared for the children with a complex of remedial gymnastics exercises.

     All children have remedial gym three times a week at school, and those with problems –do additional exercises at home with their parents.

 

Health educational program to prevent febrile seizures in children under two in Vratza

 

Mrs. Tzvetelina Ivanova

 

     The staff of the maternity ward in Vratza was involved in the project. On discharge from the ward, the head nurse gives all mothers of newborns brochures with instructions how to prevent febrile seizures in the home.          Thermometers were provided for the babies born to poor mothers.The results will be analyzed after six months.

 

Health education program for 160 high school students in Emlian Stanev High School in Veliko Turnovo

 

Mrs. Stelka Koeva

 

     The team of the project includes the director of the school Mr. Kazakov, Mrs. Tzaneva (school psychologist), Mrs. Ganeva (hygiene and epidemiology station officer), Dr. Hadjiraedv, Dr. Angelov and Dr. Bogdanov.

Once a week, talks were organized with the students. For some of the topics covered (HIV/AIDS, drugs, contraception, STIs) videos and brochures were provided by the local hygiene and epidemiology station. All talks were adapted for the age of the students - 17.

Collaboration with other organization for the program will be established.

 

Health education for hypertensive patients registered for follow-up in a general practice in Kaspichan

 

Mrs. Milena Nedeva 

 

     The practice covers 2,272 patients, of whom 178 have been registered for follow-up because of  hypertension. Of the latter, 47 are with hypertension only, and 131 are followed for two to four conditions (ischemic heart disease, cerebrovascular disease, diabetes, etc.)

     The body mass index was defined for those registered for follow-up – 38      were overweight, and 19% were obese. Cholesterol levels were checked in 26 patients, and 20 were found with levels higher than 5.2 2 mmol/.    Diabetes was found in four patients, and pyelonephritis - in two.

     The inquiry carried out to assess their level of knowledge on control of hypertension showed they need education. Twice a week, they have their blood pressure and weight checked, and are given advice on risk factors.           Each patient is given a leaflet with instructions on proper diet and daily regimen.

     A local firm – “Faience” has provided a room where the patients can be seen at a time that suits both coordinator and patients. The aim is to bring blood pressure back to normal in 30% of the cases.

 

Training patients with hepatitis В and С registered at the regional hospital in Pleven for treatment with INTERFERON in the home

 

Mrs. Maya Pelkova

 

     Leaflets on hepatitis B and C were prepared for the patients. Each patient who receives interferon (Roferon - A) gets a chart for follow-up on discharge from hospital. The chart contains information for the GP on the treatment received, dosages and follow-up investigations necessary.

     Each patient admitted is instructed how Roferon is given subcutaneously, and their skills to do it are checked every day while in hospital.

     The project has got support form the staff of the ward. Shortening of the hospital stay and improvement in follow up is expected.

 

Reduction of caries incidence in 150 children aged 6-10 in Vassil Levski School – Iskar

 

Mrs. Yana Glogovska

 

     The head of the school and the parents were introduced to the aims of the project. Drinking water was investigated to determine the quantity of fluorine. In October, fluorine treatment was started, together with training the children rules of proper oral hygiene. A brochure “How to prevent caries” was prepared and given to the children.

     Parents and school staff supported the implementation.

A Bulgarian firm provided toothbrushes and pastes. The municipality has showed willingness to support it too.

 

Raising the level of knowledge on chlamydial infection among women attending a gynecology consulting room in Rouse

 

Mrs. Plamena Polichronova

 

     Brochures were prepared with the financial support of Vavilon pharmaceutical company, and distributed to general practice consulting rooms.

Posters, questionnaires and brochures are to be prepared and distributed to schools and more GP practices.

 

Setting up a room for teaching and playroom at the pediatric ward of the regional hospital in Vidin

 

Mrs. Daniela Nicholova

 

     A room was provided, and sponsors found to redecorate it. Furniture was provided. Further equipment is to be purchased to ensure that the children admitted to the ward for treatment have a place to play and learn.

 

Training students of the medical college in Pleven safety procedures to avoid accidents during their practice in the clinical laboratory

 

Mrs. Ivanka Stoikova

 

     The project was presented and approved by the medical college. Brochures were prepared with safety rules in processing blood and urine specimens, and working with reagents.

     The project was started in September 2000.

 

Increasing the number of tutor nurses trained in the nursing methods at the clinic of pediatrics in the university hospital in Pleven

 

Mrs. Anka Hristova

 

     Project activities have been coordinated with the nursing college staff in Pleven, and the staff of the clinic.

An inquiry is planned to assess the needs of the tutor nurses.

     A training course is planned for six weeks, 2 hours a week. The project is to be completed in June 2001.

 

Health education to prevent obesity in school children in Christo Botev School in Nicopol

 

Mrs. Veronica Vladimirova

 

     The project was started in September 2000, and is to be completed in June 2001. Activities were discussed with the municipal education department, and the teaching staff. 

     A brochure was prepared for the children, advising on how to fight overweight kilograms, as well as a program for talks on specific topics.  A brochure is to be prepared for parents.

    

A training program for ambulance drivers to give first aid in road accidents

 

Mrs. Violeta Vassileva

 

     A team was formed and the target group selected.

     The team has designed a program for training and two brochures and a level test was prepared.  The project is to be completed in June 2001.

 

A health education program on healthy life style (diet, non-smoking) for hypertensive patients in a GP practice in Staroseltzi, Pleven region

 

Mrs. Snezhana Bogdanova

 

     Two meetings were organized with hypertensive patients were organized (in August and October). A radio talk was organized on the local radio.

     Full blood tests, cholesterol levels and weight are checked on a regular basis.

 

A program for the nursing staff of the admission ward of the regional hospital in Rouse to ensure effective use of consumables

 

Mrs. Angela Straus-Koleva

 

 

     A discussion was organized at the ward. A poster was prepared to present prices of consumables for the staff. A form was designed and introduced into everyday work, which allows for control on how consumables are spent.

     The aim of the project is to reduce overall spending of consumables by 10%.

 

Providing balanced diet for 20-30 socially disadvantaged children aged 0-3 in Svishtov

 

Mrs. Ventzislava Georgieva

 

     The project was presented to the staff of the baby food center in Svishtov, and 20 children were included in the program.

     A campaign was started to raise funds.