Спонсорирано от:      Dreyfus Health Foundation

DHF, 205 East 64 Street, Suite 404

New York, NY 10021

E-mail: Postmaster@thf.org

http://www.thf.org

                                        Fax #  212-371-2776

 

Съдържание

 

Новини

News

Medline Information

o      Detection of Endometrial Cancer / Диагностициране на рак на ендометриума

o      Detection of Cervival Cancer / Диагностициране на рак на маточната шийка

o      Breast Cancer Screening / Скрининг за диагностициране на рак на гърдата

o      Palliative Care for Terminal Cancer Patients / Палиативни грижи за терминално болни от рак

Инициатива за по-добро здраве – Габрово: Проекти в ход

Gabrovo Initiative Projects in Action (brief reports)

 

Новини

 

Срещи

ü    На 10 юни международни и български фасилитатори – д-р Ян Соботка, регионален координатор на програмите на Здравна фондация “Драйфус” за Европа и Близкия изток, д-р Катаржина Брочек (Полша), д-р Камен Каменов и г-жа Янка Цветанова, посетиха Общинския превантивно-информационен център по проблемите на наркоманиите в София. Д-р Захари Николов, директор, представи дейностите и целите на центъра.

      Обсъдени бяха възможностите за сътрудничество между Центъра и организирането на семинар “Решаване на проблеми за по-добро здраве” в София

ü    На 7 август г-жа Янка Цветанова представи програмите на Здравна фондация “Драйфус” на среща с г-н Найден Зеленогорски, кмет на Плевен.

      Плевенската община сътрудничи на програмите на фондацията от 1994 година. Понастоящем основно общината финансира дейността на Младежкия превантивен център в Плевен, който е един от първите в страната, а Плевен е един от градовете, най-малко засегнати от наркомании сред младите хора.

Обсъден бе новият семинар за решаване на проблеми за по-добро здраве, ориентиран към ранната диагностика на рака и палиативни грижи.

ü    Регионалният център по здравеопазване – Плевен оказа помощ при организирането на семинар “Решаване на проблеми за по-добро здраве”, ориентиран към проблемите на ранна диагностика на рака и палиативни грижи. Със съдействието на д-р Пламен Керековски, директор и д-р Любчо Лаков, зам. директор на центъра, за участие в семинара бяха поканени за участие лекари и медицински сестри от първичната здравна помощ от Ловешки, Великотърновска, Габровска и Плевенска област.

 

 

Посещения на проекти

На 11 юни д-р Ян Соботка, д-р Катаржина Брочек, доц. Мария Александрова, д-р Анжелика Велкова и г-жа Янка Цветанова посетиха проекти от “Инициатива за по-добро здраве за Габрово” в МБАЛ – Габрово. Координаторите на проекти представиха дейностите по проектите и резултатите, постигнати до момента.

 

 

 

 

Г-жа Мариана Станкова и г-жа Анелия Великова са внедрили програма за намаляване на броя на ненужните спешни изследвания в клиничната лаборатория и намаляване на разходите.

 

 

 

 

Г-жа Нели Тодорова бе горда, че до момента 70 сестри, акушерки, рехабилитатори, клинични лаборанти и фелдшери са завършили компютърни курсове, и че някои от работните места в болницата вече се компютъризират.

Три проекта са ориентирани към пациентите с остър инфаркт на миокарда. Проектите целят да се подобри проследяването и терапията (д-р Мирослав Стоянов), да се обучат пациентите с цел намаляване на броя на повторно настаняваните за болнично лечение (г-жа Иванка Младенова), и да се подобри проследяването и здравословния начин на живот на пациентите (г-жа Ганка Димитрова).

Други проекти имат за цел да се подобри ранната диагностика на рак на гърдата (д-р Станка Борисова), колоректален рак (д-р Тодор Шандурков) и рак на белия дроб (д-р Красимир Дончев).

Директорът на МБАЛ – Габрово д-р Божидар Паралчев и зам. директорът д-р Антоанета Стойкова, също координатори на проекти по програмата “Решаване на проблеми за по-добро здраве”, са оказали помощ при реализирането на проектите. Те смятат, че тези проекти спомагат за подобряване на качеството на болничните грижи.

По-късно фасилитаторите посетиха Националния музей на образованието. В една от залите на музея бе изложбата на най-добрите рисунки, карикатури, есета и стихове от деца от Основно училище “Неофит Рилски”. Творбите са създадени в рамките на проекти от програмата “Инициатива за по-добро здраве на Габрово, реализирани в училището от г-жа Пепа Йотева и г-жа Мая Колева. Двата проекта имат за цел да предпазят децата от употребата алкохол, наркотици и пушене, и да повишат здравната им култура.

Посетено бе и самото училище, където бе разгледана спортната зала за провеждане на лечебна физкултура за деца с леки гръбначни изкривявания, организирана от екипа по проекта на г-жа Петя Тошкова.

 

Семинари за проследяване на работата по проекти

 

 

 

 

На 11 юни в Габрово бе проведен семинар за проследяване на проекти от семинар “Инициатива за по-добро здраве за Габрово.” Той бе организиран в сътрудничество с клуб “Отворено общество” – Габрово.

Представена бе работата по 21 проекта от семинара, проведен през октомври, 2000 г.

 

 

 

 

 

ü    Отдиференциране на спешните от рутинните клинично-лабораторни изследвания и постигане на добра колаборация между лаборатория и отделения в МБАЛ - АД- гр. Габрово -Мариана Станкова, Анелия Великова

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

ü    Програма за обучение, разясняване на населението нуждите от хоспис за обгрижване на тежко болни, самотни стари хора, и тежко болни в терминален стадий в Габровска област -
д-р Н. Дамянова

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

ü    Подобряване на хигиената, частично залесяване и повишаване екологичната култура на студентите на територията на студентски общежития на Технически университет – гр. Габрово - Андриан Василев

ü    Здравно-образователна програма за намаляване хоспитализициите на болни след преживян инфаркт на миокарда - Иванка Младенова

ü    Проект за адекватно оборудване и работа на бронхологичен кабинет - д-р Красимир Дончев

ü    Програма за проследяване и обучение на 40 пациента след прекаран остър миокарден инфаркт - Ганка Димитрова

ü    Здравно-образователна програма за ранно откриване рака на женската гърда и психо-терапевтична помощ за жените с този проблем - д-р Станка Борисова

ü    Създаване на сестринско звено за здравни грижи по домовете на терминално болни - Снежана Георгиева, Галя Петрова

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

ü    Комплексна здравно-образователна програма за деца на възраст от 12 до 18 години в две учебни заведения в гр. Габрово” – д-р Христина Панова

ü    Програма за социализация на децата (0-3 г.) в ДМСГД гр. Габрово - Илияна Донкова

ü    Събиране на достоверна информация за извършените суицидни опити и намерения за такива, установяване на причините за тях и откриване на телефонна линия, работеща денонощно “Телефон на доверието” - д-р Севдалина Йотева

ü    Ранна профилактика на посттравматична остеопороза при жени в активна трудова възраст -  д-р Дора Чернева

ü    Обучение на медицински сестри, рехабилитатори, лаборанти, акушерки и фелдшери в начални компютърни умения - Нели Тодорова

 

 

 

 

 

 

 

 

ü    Намаляване на процента на децата с гръбначни изкривявания в ОУ “Н. Рилски” – Габрово- Петя Тошкова

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ü    Програма за превенция на тютюнопушенето сред деца на възраст от 8 до 15 години в ОУ “Неофит Рилски”- Габрово - Пепа Йотева

 

 

 

 

 

 

 

 

 

 

ü    Повишаване здравната култура и информираността на учениците от ІІ ОУ на възраст 12-14 години, по отношение на алкохола, наркотиците и вредата от тях за организма - Мая Колева

ü    Ранна диагностика на колоректален рак - д-р Тодор Шандурков

ü    Откриване на танцувални групи за профилактика и навременно коригиране на плоскостъпие и изграждане на правилна стойка при деца от 4-10 години - Ценислав Влъкненски

 

На 13 юни във Варна се проведе семинар за проследяване на работата по проекти. Координатори на проекти, разработени по време на семинара за превенция на наркоманиите, проведен през май, 2000 г., представиха докъде са стигнали с работата си по тях. “Всички проекти са интегрирани в дейността на Центъра за превенция на наркоманиите,” заяви г-жа Светла Коева, директор на Центъра. Варненската община подкрепя дейността на Центъра: градът е един от най-сериозно засегнатите в страната от наркоманиите сред младите хора.

 

 

 

 

 

 

Участниците, заедно с международните и местни фасилитатори – д-р Ян Соботка, д-р Катаржина Брочек, доц. Мария Александрова, г-жа Янка Цветанова, г-жа Светла Коева и г-жа Гергана Момова, обсъдиха извършеното по 14 проекта:

 

 

 

 

 

 

ü    Програма за намаляване честотата на заразяване с хепатит В и С, и БППП  - д-р Борислав Станчев

ü    Здравно-образователна програма по проблемите на наркоманиите за деца на 11-12 години в три училища на Варна – д-р Елена Генева

ü    Намаляване на тютюнопушенето сред студентите от медицински колеж - Варна - д-р Николай Темнялов

ü    Здравно-образователна програма за 150 деца за вредното въздействие на психоактивните вещества - Фидан Асенов

ü    Обучение на неформални лидери за провеждане на обучение връстник-връстник по проблемите на наркотиците – Илиян Ризов

ü    Просветна програма за родители за психоактивни вещества, употребата им, пристрастяване и последиците – Албена Вълчева

ü    Повишаване на бдителността на родителите към възможността децата им да експериментират с наркотици във времето, прекарвано извън семейството – Гергана Момова

ü    Health education on drug use for children aged 7-11 - Красимира Шидерова и Евгения Колева

ü    Обучителна програма за журналисти по медико-социалните проблеми на наркоманиите и превенцията им – Светла Коева

ü    Психологична помощ за превенция на наркоманиите сред срочнослужещите във Варненски гарнизон – Меглена Дерешева

ü    Превенция на наркоманиите срез деца от началния курс: организиране на алтернативни занимания чрез включване в драматичен състав - -Милена Пеева и Нели Братоева

ü    Повишаване на нивото на знания по проблемите на наркоманиите сред учителите и социалните работници във Варна – Петромила Атанасова

ü    Организиране на клуб “Свободна младежка територия” за помощ на подрастващи в кризисни за възрастта им ситуации – Румяна Иванова

ü    Обучителна програма за деца на възраст 7-11 да устояват на предлаганите наркотици – Нора Момчева

ü    Здравно-образователна програма за вредата от наркотиците за деца на 12-18 години от три варненски училища – Албена Вълчева

 

Съобщения

Бюлетинът “Комуникации за по-добро здраве” вече може да бъде намерен в Интернет на адрес:

http://www.livebg.net/psbh-digest

Очакваме вашите коментари и предложения на адрес

yapsbh@mbox.digsys.bg

В следващия брой ще прочетете за:

ü    семинар за проследяване на проекти, проведен на 29 август в Плевен;

ü    семинар “Решаване на проблеми за по-добро здраве”, ориентиран към ранна диагностика на рака и палиативни грижи, проведен в Плевен на 30 август - 1 септември, и организиран от Здравна фондация “Драйфус”, Община Плевен, ВМИ - Плевен, Факултет по здравни грижи - Плевен и РЦЗ - Плевен;

ü    семинар “Решаване на проблеми за по-добро здраве”, проведен в София на 3-5 септември и организиран от Здравна фондация “Драйфус”, Превантивно-информационен център по проблемите на наркоманиите - община София, и Столична хигиенно-епидемиологична инспекция.

 

 

News

 

Meetings

ü    On June 10th, a group of international and local facilitators – Dr. Jan Sobotka (Poland), DHF coordinator for Europe and the Middle East, Dr. Katarzyna Broczek (Poland), Dr. Kamen Kamenov and Mrs. Yanka Tzvetanova visited the Sofia Municipality Drug Abuse Information and Prevention Center. Dr. Zahari Nikolov, Director, presented the activities of the center.

Possibilities for cooperation between the Dreyfus Health Foundation (DHF) programs and the center were discussed, and the organizing of a workshop in Sofia.

ü    On August 7th, Mrs. Yanka Tzvetanova presented the PSBH and CBH programs to Mr. Naiden Zelenogorski, Mayor of Pleven –.

The Pleven municipality has been supportive to the Dreyfus Health Foundation programs since 1994.At present, the municipality supports the Drug Abuse Prevention Center in Pleven. The center is one of the first such centers set up in the country, and Pleven is among the regions in the country with lowest incidence of drug abuse in young people.

The new PSBH workshop on early diagnosis of cancer and palliative care was discussed.

ü    At the Regional Health Center, Dr. Plamen Kerekovski, Director, and Dr. Lyubcho Lakov, Deputy Director, supported the organizing of the PSBH workshop on early diagnosis of cancer and palliative care. Nurses and doctors from primary health care in Pleven, Gabrovo, Lovetch and Veliko Turnovo region were invited to the workshop through the Regional Health Centers.

 

 

Site-Visits

On June 11th, Dr. Sobotka, Dr. Broczek, Assoc. Prof. Maria Alexandrova, Dr. Angelika Velkova and Mrs. Yanka Tzvetanova visited projects at the regional Hospital in Gabrovo. The coordinators of projects implemented in the hospital reported progress made and results achieved.

Mrs. Mariana Stankova and Mrs. Anelia Velikova (see picture) implemented a program to reduce the number of unnecessary emergency lab tests and make the lab investigation more cost-effective.

Mrs. Nelly Todorova was proud that 70 nurses, midwives and other junior hospital staff members had already taken computer courses, and some of the working places in the hospital were in the process of being computerized.

Three projects had acute myocardial patients as their target group. The projects aimed to improve follow-up and therapy (Dr. Miroslav Stoyanov), to educate the patients so as to reduce the number of re-admissions to hospital (Mrs. Ivanka Mladenova), and to improve on the follow-up and life style of these patients (Mrs. Ganka Dimitrova).

Other projects aimed at improving the early diagnosis of breast cancer (Dr. Stanka Borissova), colorectal cancer (Dr. Todor Shandurkov) and lung cancer (Dr. Krassimir Donchev).

The director and deputy director of the hospital – Dr. Bozhidar Paralchev and Dr. Antoaneta Stoikova, themselves coordinators of PSBH projects, supported the coordinators of all projects, and expressed their belief, that these had helped to improve the quality of hospital care.

Later, the group of facilitators visited the National Museum of Education in Gabrovo. In one of its halls, the best drawings, caricatures, essays, and poems by children from Neophit Rilski Middle School were exhibited. These had been produced as part of PSBH projects (of Mrs. Pepa Yoteva and Mrs. Maya Koleva) implemented at the school. The projects aimed to prevent drug and alcohol use among the children, and educate them on the harmful effects of drugs, alcohol and smoking on health.

The facilitators visited the school itself, and saw the gym equipped for remedial gymnastics for children with incorrect posture, organized by the team of Mrs. Petya Toshkova

 

Follow-up Workshops

On June 11th, a follow-up workshop was held in Gabrovo. (see picture) It was organized in collaboration with the Open Society Clubs. Progress on twenty-one projects from the Gabrovo Initiative Workshop were presented:

ü    Reducing the number of unnecessary emergency lab tests by improving on the collaboration between the wards and the clinical laboratory of the regional hospital in Gabrovo - Mrs. Mariana Stankova, Mrs. Anelia Velikova

ü    Health Education and setting up support groups for disabled people in Gabrovo - Mrs. Stefka Racheva

ü    A program for training personnel and advertising the need of a hospice on the territory of Gabrovo region to meet the needs of nursing for severely ill and lonely elderly people, and terminal patients - Dr. Nina Damyanova

ü    Improvement of the follow-up and therapy for AMI patients - Dr. Miroslav Stoyanov

ü    Improving the hygiene and ecological culture if students at the technical university of Gabrovo - Mr. Andrian Vassilev

ü    Health educational program to reduce the readmissions to hospital of acute myocardial infarction patients - Mrs. Ivanka Mladenova

ü    Improving the work in a lung disease consulting room - Dr. Krassimir Donchev

ü    A program to follow up and educate 40 acute myocardial infarction patients - Mrs. Ganka Dimitrova

ü    A Health education program for early diagnosis of breast cancer and psychological support for women after mastectomy - Dr. Stanka Borissova

ü    Organizing a team to provide nursing care for terminal patients in the home - Mrs. Snezhana Georgieva, Mrs. Galya Petrova

ü    Spreading information about the suicide prevention program - Mrs. Elisa Kovacheva

ü    A health educational program for children aged 12-18, attending two schools in Gabrovo - Dr. Christina Panova

ü    A program to improve on the integration skills of children aged 0-3 years, from an orphanage in Gabrovo - Mrs. Iliana Donkova

ü    Collecting information about suicide attempts and intentions, investigation of causes and starting a 24-hour hot line - Dr. Sevdalina Yoteva

ü    Early prophylaxis of post-traumatic osteoporosis in women aged 30-60 - Dr. Dora Cherneva

ü    Computer training for nurses, physiotherapeutists, lab technicians, midwives and feldschers - Mrs. Nelly Todorova

ü    Reducing the rates of spinal deformities in children in Neophit Rilski Middle School in Gabrovo - Mrs. Petya Toshkova (see picture)

ü    Anti-smoking program for children aged 8-15 attending Neophit Rilski Middle School in Gabrovo - Mrs. Pepa Yoteva (see picture)

ü    Raising the level of knowledge on the harmful effect of drugs and alcohol in schoolchildren aged 12-14, attending Neophit Rilski Middle School in Gabrovo - Mrs. Maya Koleva

ü    Early diagnosis of colorectal cancer - Dr. Todor Shandurkov

ü    Correction of flat foot deformities and incorrect posture in children aged four to ten through dancing lessons - Mr. Tsenislav Vlaknenski

 

 

On June 13th, there was a follow-up workshop in Varna. The project coordinators of projects, prepared during the PBSH workshop on drug abuse prevention (held in May 2000) reported progress on their projects. “These projects are all integrated in the activities of the Drug Abuse Prevention Center’, said Mrs. Svetla Koeva, Director of the Center. The municipality of Varna supports the center, so as to realize the plans for achieving more in the struggle against drugs: the town is one of the worst affected in the country. 

The participants, international and local facilitators – Dr. Jan Sobotka, Dr. Katarzyna Broczek, Assoc. Prof. Maria Alexandrova, Mrs. Yanka Tzvetanova, Mrs. Svetla Koeva and Mrs. Gergana Momova discussed progress on 14 projects: (see picture)

ü    A program to reduce the number of drug users  infected with hepatitis В and С, and STIs by providing a program to prevent them from sharing needles - Dr. Borislav Stanchev

ü    Health education on the problems of drug use and abuse for children aged 11-12 in three schools in Varna - Dr. Elena Geneva

ü    Reduction of smoking rates in student nurses in the College of Nursing in Varna – Dr. Nickolay Temnyalov

ü    Health education for 150 children on the harmful effect of psychoactive substances – Mr. Fidan Assenov

ü    Training group leaders for peer education programs on drug abuse - Mr. Ilian Rizov

ü    An educational program for parents on psychoactive drugs, drug use and abuse, addiction and consequences - Mrs. Albena Valcheva

ü    Raising the awareness of parents to the issue of their children experimenting with drugs  outside the family - Mrs. Gergana Momova

ü    Health education on drug use for children aged 7-11 - Mrs. Krassimira Shiderova and Mrs. Evgenia Koleva

ü    An educational program for journalists on medico-social problems of drug addiction and prevention - Mrs. Svetla Koeva

ü    Psychological help for prevention of drug abuse among soldiers in the Varna garrison - Mrs. Meglena Deresheva

ü    Prevention of primary drug use in elementary school children by involving them in a drama circle - Mrs. Milena Peeva and Mrs. Nelly Bratoeva

ü    Raising the level of knowledge of drug abuse related issues among school teachers and social workers in Varna - Mrs. Petromila Atanassova

ü    Organizing a club “Free Youth Territory” to support adolescents solve age-related problems - Mrs. Roumyana Ivanova

ü    A training program for children aged 7-11 to resist drugs offered by drug dealers – Mrs. Nora Momcheva

ü    Health education on the harmful effect of drugs for children aged 12-18 in three schools in Varna – Mrs. Albena Valcheva

 

Announcements

The Bulgarian Health Information Digest is also available on the Internet, at

www.livebg.net/psbh-digest

Your comments and suggestions are most welcome.

Please write to: yapsbh@mbox.digsys.bg

 

In the next issue, you will read about:

ü    The follow-up PSBH workshop for nurses, held in Pleven on July 29, at the Balkan Hotel;

ü    the PSBH workshop on early diagnosis of cancer and palliative care, held in Pleven on August 30-September 1, organized by Dreyfus Health Foundation, in collaboration with Pleven Municipality, University School of Medicine – Pleven, Pleven Faculty of Nursing, and the Pleven Regional Health Center

ü    first PSBH workshop in Sofia, held in Sofia, September 3-5, and organized by Dreyfus Health Foundation, in collaboration with the Sofia Municipality Drug Abuse Information and Prevention Center and the Sofia Hygiene and Epidemiology Center.

 

 

Medline Information

 

Detection of Endometrial Cancer / Дагностициране на рак на ендометриума

 

AU:     Tsankova M, Nalbanski B, Borisov I, Borisov S

TI:       [A comparative study between hysterosalpingography and laparoscopy in evaluating female infertility]

SO:      Akush Ginekol (Sofia). 2000. 39(1). P 20-2.

MH:    Hysterosalpingography:*. Infertility, Female:*DI/ET. Laparoscopy:*. Adult. Fallopian Tube Diseases:CO/DI. Menstrual Cycle. Methylene Blue:DU. Prospective Studies. Sensitivity and Specificity. Check Tags: Comparative Study. English Abstract. Female. Human.

AB:     The diagnostic accuracy of hysterosalpingography and laparoscopy was compared. One hundred forty three infertile women were prospectively investigated in two years duration. Laparoscopic chromopertubation using methylen blue dye performed on days 8-16. Hysterosalpingography performed on days 7-10 with water soluble contrast medium. There was agreement between the results of both methods in 66.4 per cent /95/ of the patients. In 15 of the 63 patients with a normal hysterosalpingography, however, peritubal or tubal disease was observed at the time of laparoscopy/false-negative results, 10.4%/Eighty patients with tubal obstructions were detected by hysterosalpingography, but 33 obstructions were not confirmed by laparoscopy/false-positive results, 23%/. The greatest discrepancy between the hysterosalpingography and laparoscopy was found in peritubal adhesions--58.7%. Laparoscopic evaluation demonstrated also endometriosis in 41 cases, polycystic ovaries in 12, ovarian cyst in 9, and uterine fibroids in 15. Intrauterine abnormalities were diagnosed by hysterosalpingography in only 2.9% per cent of the patients. No significant laparoscopic complications were noted. The results suggest that hysterosalpingography is useful as a primary screening procedure, but laparoscopy provides a more accurate assessment of tubal patency and peritoneal factors in the investigation of infertility.

 

 

AU:     Zanotti KM, Kennedy AW

AD:     Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Ohio, USA. zanottk@cesmtp.ccf.org

TI:       Screening for gynecologic cancer.

SO:      Med Clin North Am. 1999 Nov. 83(6). P 1467-87.

MH:    Genital Neoplasms, Female:*DI/*PC. Mass Screening:*. Cervix Neoplasms:DI/PC. Endometrial Neoplasms:DI/PC. Ovarian Neoplasms:DI/PC. United States. Vaginal Smears. Check Tags: Female..  Human.

AB:     Screening for cervical cancer with the Pap test has significantly reduced mortality from the disease. Although screening for ovarian and endometrial cancer is desirable, suggested strategies have not demonstrated efficacy. For the present time, educating patients with regard to the symptoms associated with these diseases and prompt evaluation of women who present with these symptoms helps limit unnecessary diagnostic delay.

 

 

AU:     Love CD, Muir BB, Scrimgeour JB, Leonard RC, Dillon P, Dixon JM

AD:     Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom.

TI:       Investigation of endometrial abnormalities in asymptomatic women treated with tamoxifen and an evaluation of the role of endometrial screening

SO:      J Clin Oncol. 1999 Jul. 17(7). P 2050-4.

MH:    Antineoplastic Agents, Hormonal:*AE. Breast Neoplasms:*DT. Endometrial Neoplasms:*CI/EP/*PC. Mass Screening:*MT. Tamoxifen:*AE. Adult. Aged. Great Britain:EP. Hysteroscopy. Middle Age. Sensitivity and Specificity. Statistics, Nonparametric. Ultrasonography. Check Tags: Comparative Study..  Female..  Human..  Support, Non-U.S. Gov’t.

AB:     PURPOSE: Tamoxifen is the most commonly prescribed adjuvant therapy for women with breast cancer. It has agonist activity on the endometrium and is associated with an increased risk of endometrial cancer. The aim of this study was to evaluate whether screening with transvaginal ultrasound (TV USS) with or without hysteroscopy is worthwhile. PATIENTS AND METHODS: A total of 487 women with breast cancer, 357 treated with tamoxifen and 130 controls, were screened with TV USS, and endometrial thickness was measured. Women with thickened endometrium underwent outpatient hysteroscopy. RESULTS: Length of time on tamoxifen ranged from 5 to 191 months (mean, 66 months), and endometrial thickness ranged from 1 to 38 mm (mean, 7.3 mm). Women treated with tamoxifen had significantly thicker endometrium than did controls (P <.0001). There was a statistically significant (P <.0001) positive correlation between length of time on tamoxifen and endometrial thickness. One hundred forty-five women had endometrium greater than 5 mm on USS, and 134 underwent successful outpatient hysteroscopy, 61 of whom had atrophic endometrium, resulting in a 46% false-positive scan rate. The remaining women all had benign features to explain the USS findings. CONCLUSION: TV USS detects a high incidence (41%) of apparent endometrial thickening in women treated with tamoxifen, although 46% had atrophic endometrium on further assessment, and none of the remaining asymptomatic women had significant lesions. Length of time on tamoxifen relates to endometrial thickening as measured by TV USS. TV USS is a poor screening tool because of the high false-positive rate. The low frequency of significant findings suggests that endometrial screening in asymptomatic women is not worthwhile.

 

 

AU:     Ivanov S, Ivanov S

TI:       [The progesterone test and transvaginal sonography as methods for the early discovery and screening of endometrial cancer in women in the postmenopause from some risk groups]

SO:      Akush Ginekol (Sofiia). 1999. 38(2). P 29-30.

MH:    Carcinoma:CI/*DI/DT.EndometrialNeoplasms:CI/*DI. Endometrium:DE/*US. Postmenopause:*. Progesterone:*DU. Antineoplastic Agents, Hormonal: AE/TU. Breast Neoplasms:DT. Carcinogens:AE. Middle Age. Risk Factors. Tamoxifen:AE/TU. Time Factors. Vagina. Check Tags: English Abstract..  Female..  Human.

AB:     We wanted to assess the effect of tamoxifen-treated women with breast cancer, as well as to examine patients with diabetes blood hypertension and obesity. The influence of Tamoxifen was searched over the endometrium in patients treated with it for 3 years. In this research work is assessed the effect of this medicament from this risk group. The second risk group were the women with high blood pressure, obesity and diabetes mellitus. We used transvaginal sonography and the progesterone test to find endometrial pathology and especially endometrial cancer in asymptomatic women, measuring the depth of the endometrium, and using abrasio probatoria separata in order to find endometrial cancer. With these tests we found polyps, hyperplasia, and early endometrial cancer. We wanted, using the progesteron test and vaginal sonography in these risk groups, to find endometrial pathology and especially early endometrial cancer in asymptomatic women.

 

 

AU:     Elit L

AD:     Hamilton Regional Cancer Centre, Division of Gynecologic Oncology, ON.
 laurie.elit@hrcc.on.ca

TI:       Endometrial cancer. Prevention, detection, management, and follow up.

SO:      Can Fam Physician. 2000 Apr. 46(4). P 887-92.

MH:    Endometrial Neoplasms:*/DI/PC/TH. Adult. Antineoplastic Agents, Hormonal: AE. Biopsy. Breast Neoplasms:PC. Endometrium:PA. Estrogen Replacement Therapy. Follow-Up Studies. Middle Age. Neoplasm Recurrence, Local:PC. Progesterone:AD. Prognosis. Randomized Controlled Trials. Risk Factors. Tamoxifen:AE. Check Tags: Comparative Study..  Female..  Human.

AB:     OBJECTIVE: To review risk factors for uterine cancer; to discuss strategies for detecting uterine cancer; to outline prognostic factors and treatment; and to review the role of follow up for patients who have completed primary therapy. QUALITY OF EVIDENCE: MEDLINE was searched from January 1996 to June 1998 using the terms endometrial neoplasms, estrogen replacement therapy, hormone replacement therapy, tamoxifen, and screening. Only English language articles were reviewed. Study types included reviews. Bibliographies of articles found were searched for further relevant titles. Causation literature is available from well conducted cohort trials. Treatment recommendations are based in part on prognostic information and a few randomized controlled trials. MAIN MESSAGE: Risk factors, both intrinsic and extrinsic, are associated with uterine cancer. Family physicians have a role in preventing disease by ensuring that all women with uteri in situ using hormone replacement therapy (HRT) have progesterone therapy as part of the HRT regimen. Detection is crucial; abnormal uterine bleeding or undiagnosed postmenopausal bleeding warrants investigation with endometrial biopsy. The goal of surgery is to remove the uterus and ovaries and identify factors that make the disease at high risk of recurrence. Although adjuvant radiation therapy does not prolong survival, it does alter the pattern of disease recurrence. The goal of follow up after primary therapy is to identify recurrent disease while it is still curable. CONCLUSIONS: Family physicians play an important role in preventing uterine cancer, initiating early diagnosis of disease, and in the future, might be more actively involved in caring for patients following primary therapy.

 

 

Detection of Cervival Cancer / Диагностициране на рак на маточната шийка

 

AU:     Nanda K, McCrory DC, Myers ER, Bastian LA, Hasselblad V, Hickey JD, Matchar DB

AD:     Duke University Medical Center and Durham Veterans Affairs Medical Center, North Carolina 27705, USA. knanda@fhi.org

TI:       Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review.

SO:      Ann Intern Med. 2000 May 16. 132(10). P 810-9.

MH:    Cervix Neoplasms:*DI. Mass Screening:*MT/*ST. Vaginal Smears:*MT/*ST. Cervix Uteri:CY/PA. Diagnosis, Computer-Assisted. Sensitivity and Specificity. Check Tags: Female..  Human..  Support, U.S. Gov’t, Non-P.H.S...  Support, U.S. Gov’t, P.H.S..

AB:     PURPOSE: To evaluate the accuracy of conventional and new methods of Papanicolaou (Pap) testing when used to detect cervical cancer and its precursors. DATA SOURCES: Systematic search of English-language literature through October 1999 using MEDLINE, EMBASE, other computerized databases, and hand searching. STUDY SELECTION: All studies that compared Pap testing (conventional methods, computer screening or rescreening, or monolayer cytology) with a concurrent reference standard (histologic examination, colposcopy, or cytology). DATA EXTRACTION: Two reviewers independently reviewed selection criteria and completed 2 x 2 tables for each study. DATA SYNTHESIS: 94 studies of the conventional Pap test and three studies of monolayer cytology met inclusion criteria. No studies of computerized screening were included. Data were organized by cytologic and histologic thresholds used to define disease. For conventional Pap tests, estimates of sensitivity and specificity varied greatly in individual studies. Methodologic quality and frequency of histologic abnormalities also varied greatly between studies. In the 12 studies with the least biased estimates, sensitivity ranged from 30% to 87% and specificity ranged from 86% to 100%. CONCLUSIONS: Insufficient high-quality data exist to estimate test operating characteristics of new cytologic methods for cervical screening. Future studies of these technologies should apply adequate reference standards. Most studies of the conventional Pap test are severely biased: The best estimates suggest that it is only moderately accurate and does not achieve concurrently high sensitivity and specificity. Cost-effectiveness models of cervical cancer screening should use more conservative estimates of Pap test sensitivity.

 

 

AU:     Clark MA, Rakowski W, Ehrich B

AD:     Department of Community Health, Brown University, Providence, Rhode Island 02912, USA.

TI:       Breast and cervical cancer screening: associations with personal, spouse’s, and combined smoking status.

SO:      Cancer Epidemiol Biomarkers Prev. 2000 May. 9(5). P 513-6.

MH:    Breast Neoplasms:*EP. Cervix Neoplasms:*EP. Mass Screening:*MT. Smoking:AE/*EP. Spouses:*. Adult. Aged. Mammography. Middle Age. Palpation. Risk Factors. Vaginal Smears. Check Tags: Female..  Human..  Support, Non-U.S. Gov’t.

AB:     The objective of this study was to examine the association of women’s cancer screenings with both personal and spouses’ smoking status, as well as with the broader context of household smoking, in a United States national-level sample of women aged 42-75 years. Data were from the 1994 National Health Interview Survey Health Promotion Supplement. The sample included 1586 women who reported they were married and living with a spouse in a two-person household. Three measures of smoking status were used: personal smoking status, smoking status of spouse, and household smoking status (self and spouse smoked, spouse only smoked, self only smoked, and both nonsmokers). Using logistic regression modeling, associations were examined between the smoking status measures and three cancer screening indicators: mammogram < or =2 years, clinical breast exam < or =2 years, and Pap test < or =3 years. The both nonsmokers group consistently had the highest screening rates for all three exams. The spouse only smoking group was 10-12% less likely to obtain all three cancer screening tests compared to the both nonsmokers group. The self and spouse group was less likely to report a recent mammogram and clinical breast exam. The self only group did not differ significantly from the both nonsmokers group on any of the cancer screening measures. Results suggest that smoking status of a spouse may be an important correlate of women’s cancer screenings.

 

 

AU:     Womack SD, Chirenje ZM, Gaffikin L, Blumenthal PD, McGrath JA, Chipato T, Ngwalle S, Munjoma M, Shah KV

AD:     School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205-2179, USA. smizell@jhsph.edu

TI:       HPV-based cervical cancer screening in a population at high risk for HIV infection.

SO:      Int J Cancer. 2000 Jan 15. 85(2). P 206-10.

MH:    Cervical Intraepithelial Neoplasia:CO/*EP/VI. Cervix Neoplasms:CO/*EP/VI. HIV Infections:CO/*EP/IM. Papillomavirus, Human:GE/*IP. Papovaviridae Infections:CO/DI/*EP. Adult. DNA, Viral:AN. Enzyme-Linked Immunosorbent Assay. HIV:IM. Mass Screening. Middle Age. Predictive Value of Tests. Vaginal Smears. Zimbabwe:EP. Check Tags: Female..  Human..  Support, U.S. Gov’t, Non-P.H.S...  Support, U.S. Gov’t, P.H.S..

AB:     We determined the utility of an assay for 13 cancer-associated HPV types in primary cervical cancer screening of Zimbabwe women at high risk of HIV infection. HIV antibody status was determined by ELISA of oral mucosal specimens, and HPV DNA in the genital tract was identified by hybridization of cervical scrapes with probe B of Hybrid Capture II. Among the 466 women investigated, the prevalence of HPV, low-grade squamous intraepithelial lesions (LGSIL) and high-grade SIL (HGSIL) were 47.2%, 13.9% and 12%. Fifty-three and one-half percent of the women were HIV-seropositive. As compared with HIV-seronegative women, HIV-infected women had a greater than 2-fold HPV prevalence (64.3% vs. 27.6%), a greater than 7-fold amount of HPV DNA (RLU of 82.6 vs. 10.7) in HPV(+) women assessed as normal on the reference standard, and a nearly 3-fold greater HGSIL prevalence (17.3% vs. 5.9%). The strong link between HGSIL and HPV DNA positivity was seen in both HIV-infected and HIV-seronegative women. The amount of HPV DNA increased with disease severity in both HIV-seronegative and HIV-infected women. The sensitivity and specificity of the HPV test for HGSIL were, respectively, 90.7% (95% confidence limit 77.9-97.4%) and 41.3% (34.5-48.3%) in HIV-infected women and 61.5% (31.6-86.1%) and 74.5% (68.0-80.3%), respectively, in HIV(-) women. The usefulness of the HPV test as a screening test for cervical cancer in areas of high HPV prevalence will depend upon local health resource availability, disease priorities and policies regarding clinical case management. Copyright 2000 Wiley-Liss, Inc.

 

 

AU:     Schiffman M, Herrero R, Hildesheim A, Sherman ME, Bratti M, Wacholder S, Alfaro M, Hutchinson M, Morales J, Greenberg MD, Lorincz AT

AD:     Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. schiffmm@exchange.nih.gov

TI:       HPV DNA testing in cervical cancer screening: results from women in a high-risk province of Costa Rica

SO:      JAMA. 2000 Jan 5. 283(1). P 87-93.

MH:    Cervical Intraepithelial Neoplasia:DI/*PC/VI. Cervix Neoplasms:DI/*PC/VI. DNA, Viral:*AN. Mass Screening:*/MT. Papillomavirus, Human:GE/*IP. Papovaviridae Infections:*DI. Tumor Virus Infections:*DI. Adult. Aged. Colposcopy. Costa Rica. Middle Age. Sensitivity and Specificity. Vaginal Smears. Check Tags: Female..  Human..  Support, Non-U.S. Gov’t..  Support, U.S. Gov’t, P.H.S..

AB:     CONTEXT: Human papillomaviruses (HPVs) are known to cause most cervical cancer worldwide, but the utility of HPV DNA testing in cervical cancer prevention has not been determined. OBJECTIVE: To provide comprehensive data on the screening performance of HPV testing for the most common carcinogenic types, at different levels of analytic sensitivity. DESIGN: Laboratory analysis conducted during 1993-1995, using 3 cytologic techniques and cervicography, followed by colposcopic examination of women with any abnormal cervical finding, to detect all high-grade intraepithelial lesions and cancer (reference standard of clinically significant disease). The HPV testing was performed subsequently with masking regarding clinical findings. SETTING: Guanacaste Province, Costa Rica, a region with a high age-adjusted incidence of cervical cancer. PARTICIPANTS: Of 11742 randomly selected women, 8554 nonpregnant, sexually active women without hysterectomies underwent initial HPV DNA testing using the original Hybrid Capture Tube test; a stratified subsample of 1119 specimens was retested using the more analytically sensitive second generation assay, the Hybrid Capture II test. MAIN OUTCOME MEASURES: Receiver operating characteristic analysis of detection of cervical high-grade intraepithelial lesions and cancer by HPV DNA testing based on different cut points of positivity. RESULTS: An analytic sensitivity of 1.0 pg/mL using the second generation assay would have permitted detection of 88.4% of 138 high-grade lesions and cancers (all 12 cancers were HPV-positive), with colposcopic referral of 12.3% of women. Papanicolaou testing using atypical squamous cells of undetermined significance as a cut point for referral resulted in 77.7% sensitivity and 94.2% specificity, with 6.9% referred. Specificity of the second generation assay for positivity for high-grade lesions and cancer was 89.0%, with 33.8% of remaining HPV DNA-positive subjects having low-grade or equivocal microscopically evident lesions. The higher detection threshold of 10 pg/mL used with the original assay had a sensitivity of 74.8% and a specificity of 93.4%. Lower levels of detection with the second generation assay (<1 pg/mL) proved clinically nonspecific without gains in diagnostic sensitivity. CONCLUSIONS: In this study population, a cut point of 1.0 pg/mL using the second generation assay permitted sensitive detection of cervical high-grade lesions and cancer, yielding an apparently optimal trade-off between high sensitivity and reasonable specificity for this test. The test will perform best in settings in which sensitive detection of high-grade lesions and cancer is paramount. Because HPV prevalence varies by population, HPV testing positive predictive value for detection of high-grade lesions and cancer will vary accordingly, with implications for utility relative to other cervical cancer screening methods.

 

 

AU:     Wright TC Jr, Denny L, Kuhn L, Pollack A, Lorincz A

AD:     Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. tcw1@columbia.edu

TI:       HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer

SO:      JAMA. 2000 Jan 5. 283(1). P 81-6.

MH:    Cervix Neoplasms:PA/*PC/VI. DNA, Viral:*AN. Mass Screening:*MT. Papillomavirus, Human:GE/*IP. Papovaviridae Infections:*DI. Tumor Virus Infections:*DI. Adult. Carcinoma in Situ:PA/PC/VI. Cervical Intraepithelial Neoplasia:PA/PC/VI. Colposcopy. Cross-Sectional Studies. Middle Age. Predictive Value of Tests. Sensitivity and Specificity. Specimen Handling. Vaginal Smears. Check Tags: Comparative Study..  Female..  Human..  Support, Non-U.S. Gov’t.

AB:     CONTEXT: More than half of the women diagnosed as having cervical cancer in the United States have not been screened within the last 3 years, despite many having had contact with the health care system. In many other regions of the world, there is only limited access to cervical cancer screening. OBJECTIVE: To determine whether testing of self-collected vaginal swabs for human papillomavirus (HPV) DNA can be used to screen for cervical disease in women aged 35 years and older. DESIGN: Cross-sectional observational study comparing Papanicolaou smears with HPV DNA testing of self-collected vaginal swabs. SETTING: Outpatient clinics in a periurban settlement outside of Cape Town, South Africa, between January 1998 and April 1999. PARTICIPANTS: Screening was performed on 1415 previously unscreened black South African women aged 35 to 65 years. INTERVENTION: Women self-collected a vaginal swab for HPV testing in the clinic and were then screened using 4 different tests: Papanicolaou smear, direct visual inspection of the cervix after the application of 5% acetic acid, cervicography, and HPV DNA testing of a clinician-obtained cervical sample. Women with abnormal results on any of the screening tests were referred for colposcopy. MAIN OUTCOME MEASURE: Biopsy-confirmed high-grade cervical squamous intraepithelial lesions or invasive cancer. RESULTS: High-grade squamous intraepithelial lesions were identified in 47 (3.4%) of 1365 women adequately assessed, and there were 9 cases of invasive cancer. Of women with high-grade disease, 66.1% (95% confidence interval [CI], 52.1%-77.8%) had high risk for HPV detected in self-collected vaginal samples, and 67.9% (95% CI, 53.9%-79.4%) had an abnormal Papanicolaou smear (P = .78). The false-positive rates for HPV DNA testing of self-collected vaginal samples and Papanicolaou smears were 17.1% (95% CI, 15.1%-19.3%) and 12.3% (95% CI, 10.5%-14.2%), respectively (P<.001). A high-risk type of HPV DNA was detected in 83.9% (95% CI, 71.2%-91.9%) of women with high-grade disease and 15.5% (95% CI, 13.6%-17.7%) of women with no evidence of cervical disease using a clinician-obtained cervical sample. CONCLUSIONS: These results indicate that HPV testing of self-collected vaginal swabs is less specific than but as sensitive as Papanicolaou smears for detecting high-grade cervical disease in women aged 35 years and older, and HPV testing offers an important new way to increase screening in settings where cytology is not readily performed.

 

 

Breast Cancer Screening / Скрининг за диагностициране на рак на гърдата

 

TI:       [Nationwide breast cancer screening fully accomplished; results from the implementation phase 1990-1997. National Evaluation Team for Breast Cancer Screening

SO:      Ned Tijdschr Geneeskd. 2000 Jun 3. 144(23). P 1124-9.

MH:    Breast Neoplasms:*DI/EC/*EP. Mass Screening:EC/*SN/TD. Age Distribution. Aged. Carcinoma, Intraductal, Noninfiltrating:DI/EP. Cost-Benefit Analysis. Incidence. Middle Age. Neoplasm Staging. Netherlands:EP. Program Evaluation. Registries. Check Tags: English Abstract..  Female..  Human.

AB:     OBJECTIVE: To present an overview of the main results of the nationwide breast cancer screening programme implemented in the Netherlands from 1990 to 1997 and providing a biennial mammography for all women aged 50-69 years. METHOD: Data on screening examinations were provided by the 9 regional screening organisations; data on interval cancers and on breast cancers in unscreened women were provided by the regional cancer registries after linkage of registry data with data on screened women. The results observed were compared with the expectations used in the cost effectiveness analysis before the start of the population screening. RESULTS: Of almost 4 million women invited, 78.5% attended for screening. The screening resulted in 13.1 referrals, 9.2 biopsies and 6.1 breast cancers detected per 1,000 initially screened women, and in 6.9 referrals, 4.5 biopsies and 3.5 detected breast cancers per 1,000 subsequently screened women. All these parameters showed a clear variation at regional level. In the first 2 years after initial screens 0.96 interval cancers per 1,000 women-years were diagnosed (0.93 per 1,000 women-years after subsequent screens). Of all screen-detected cancers 76% were ductal carcinomas in situ (13%) or invasive cancers < or = 20 mm in size (63%); 26% of the invasive cancers were lymph node positive. This stage distribution was clearly more favourable than that of interval cancers and of the breast cancers diagnosed in unscreened women. The detection of breast cancer at subsequent screening was lower than expected and the staging of the carcinomas was less favourable than expected; the other results were largely in accordance with the expectations.

 

 

AU:     van der Maas PJ

AD:     Erasmus Universiteit, Instituut Maatschappelijke Gezondheidszorg, Rotterdam. vandermaas@mgz.fgg.eur.nl

TI:       [Population screening for breast cancer: an interim assessment

SO:      Ned Tijdschr Geneeskd. 2000 Jun 3. 144(23). P 1096-9.

MH:    Breast Neoplasms:DI/*EP/MO/*PC. Mass Screening:MT/*TD. Aged. Middle Age. Netherlands:EP. Population Surveillance. Program Evaluation. Registries. Survival Analysis. Survival Rate. Check Tags: English Abstract..  Female..  Human.

AB:     The Dutch national breast cancer programme started in 1989 and ten years later complete coverage of the target population was realised. Screening will save the lives of 27% of all women with screen detected breast cancer. In the other 73% survival will not change, but they will know some years earlier that they have breast cancer. There are 4 lessons from the 12 year experience: (a) mortality reduction due to the present programme can only be identified in individual follow-up data of all women with breast cancer; (b) systematic improvement of the programme’s performance can only be based on feedback from a detailed quality and outcome monitoring system; (c) the advice to increase the upper age limit to 75 years was based on the interpretation of trial results for younger age groups and model analysis; (d) breast cancer screening contributed to the systematic improvement of clinical procedures. Current scientific and practical challenges are mortality evaluation, optimising test properties, setting upper and lower age limits, understanding regional differences, developing optimal screening frequencies in women with an elevated breast cancer risk, digital mammography and computer assisted diagnosis.

 

 

AU:     Wee CC, McCarthy EP, Davis RB, Phillips RS

AD:     Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. cweekuo@caregroup.harvard.edu

TI:       Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care

SO:      Ann Intern Med. 2000 May 2. 132(9). P 697-704.

MH:    Breast Neoplasms:*PC. Cervix Neoplasms:*PC. Mammography:*UT. Mass Screen-ing:MT/*UT. Obesity:*. Vaginal Smears:*UT. Adolescence. Adult. Aged. Analysis of Variance. Blacks. Body Mass Index. Chi-Square Distribution. Middle Age. Questionnaires. Socioeconomic Factors. Whites. Check Tags: Female..  Human..  Support, Non-U.S. Gov’t..  Support, U.S. Gov’t, P.H.S..

AB:     BACKGROUND: Compared with thinner women, obese women have higher mortality rates for breast and cervical cancer. In addition, obesity leads to adverse social and psychological consequences. Whether obesity limits access to screening for breast and cervical cancer is unclear. OBJECTIVE: To examine the relation between obesity and screening with Papanicolaou (Pap) smears and mammography. DESIGN: Population-based survey. SETTING: United States. PARTICIPANTS: 11 435 women who responded to the “Year 2000 Supplement” of the 1994 National Health Interview Survey. MEASUREMENTS: Screening with Pap smears and mammography was assessed by questionnaire. RESULTS: In women 18 to 75 years of age who had not previously undergone hysterectomy (n = 8394), fewer overweight women (78%) and obese women (78%) than normal-weight women (84%) had had Pap smears in the previous 3 years (P < 0.001). After adjustment for sociodemographic information, insurance and access to care, illness burden, and provider specialty, rate differences for screening with Pap smears were still seen among overweight (-3.5% [95% CI, -5.9% to -1.1%]) and obese women (-5.3% [CI, -8.0% to -2.6%]). In women 50 to 75 years of age (n = 3502), fewer overweight women (64%) and obese women (62%) than normal-weight women (68%) had had mammography in the previous 2 years (P < 0.002). After adjustment, rate differences were -2.8% (CI, -6.7% to 0.9%) for overweight women and -5.4% (CI, -10.8% to -0.1%) for obese women. CONCLUSIONS: Overweight and obese women were less likely to be screened for cervical and breast cancer with Pap smears and mammography, even after adjustment for other known barriers to care. Because overweight and obese women have higher mortality rates for cervical and breast cancer, they should be targeted for increased screening.CM: Comment in: Ann Intern Med 2000 May 2;132(9):732-4EM: 0006

 

 

AU:     Katz SJ, Zemencuk JK, Hofer TP

AD:     Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0376, USA. skatz@umich.edu

TI:       Breast cancer screening in the United States and Canada, 1994: socioeconomic gradients persist.

SO:      Am J Public Health. 2000 May. 90(5). P 799-803.

MH:    Breast Neoplasms:*RA. Mammography:EC/*UT. Mass Screening:EC/*UT. Age Factors. Aged. Attitude to Health. Cross-Sectional Studies. Educational Status. Health Care Surveys. Health Services Accessibility:ST. Income:SN. Knowledge, Attitudes, Practice. Middle Age. Ontario. Questionnaires. Residence Characteristics. Socioeconomic Factors. United States. Check Tags: Comparative Study..  Female..  Human..  Support, Non-U.S. Gov’t..  Support, U.S. Gov’t, Non-P.H.S...  Support, U.S. Gov’t, P.H.S..

AB:     OBJECTIVES: This study compared rates of annual mammography screening across socioeconomic status between the United States and Canada in 1994. METHODS: Population-based cross-sectional surveys were used to compare the rates. RESULTS: Screening rates were higher in the United States than in Canada for women aged 50 to 69 years (47.3% vs 38.8%; P < .01). Women with higher education and with higher incomes were more likely to receive screening in both countries, with no significant differences between countries. CONCLUSIONS: For women aged 50 to 69 years, screening rates in Canada have substantially increased relative to those in the United States. However, disparities in screening across levels of socioeconomic status persist in both countries.

** Full text is available **

 

 

AU:     Kuhl CK, Schmutzler RK, Leutner CC, Kempe A, Wardelmann E, Hocke A, Maringa M, Pfeifer U, Krebs D, Schild HH

AD:     Departments of Radiology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany.

TI:       Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: preliminary results.

SO:      Radiology. 2000 Apr. 215(1). P 267-79.

MH:    Breast:*PA. Breast Neoplasms:CL/DI/*GE/PA. Genetic Predisposition to Disease:*. Heterozygote:*. Magnetic Resonance Imaging:*. Mass Screening:*. Adult. Bayes Theorem. Biopsy. Cohort Studies. Fibroadenoma: DI. Follow-Up Studies. Genes, BRCA1:GE. Genetic Markers:GE. Mammography. Middle Age. Neoplasm Proteins:GE. Neoplasm Staging. Predictive Value of Tests. Prospective Studies. Reproducibility of Results. Risk Factors. Sensitivity and Specificity. Transcription Factors:GE. Ultrasonography, Mammary. Check Tags: Comparative Study..  Female..  Human..  Support, Non-U.S. Gov’t.

AB:     PURPOSE: To compare magnetic resonance (MR) imaging with conventional imaging in screening high-risk women. MATERIALS AND METHODS: This prospective trial included 192 asymptomatic and six symptomatic women who, on the basis of personal or family history or genetic analysis, were suspected or proved to carry a breast cancer susceptibility gene. RESULTS: Fifteen breast cancers were identified: nine in the 192 asymptomatic women (six in the first and three in the second screening round) and six in the symptomatic patients. Concerning the asymptomatic women, four of the nine breast cancers were detected and correctly classified with mammography and ultrasonography (US) combined; another two cancers were visible as well-circumscribed masses and were diagnosed as fibroadenomas. MR imaging allowed the correct classification and local staging of all nine cancers. In 105 asymptomatic women with validation of the 1st-year screening results, the sensitivities of mammography, US, and MR imaging were 33%, 33% (mammography and US combined, 44%), and 100%, respectively; the positive predictive values were 30%, 12%, and 64%, respectively. CONCLUSION: The accuracy of MR imaging is significantly higher than that of conventional imaging in screening high-risk women. Difficulties can be caused by an atypical manifestation of hereditary breast cancers at both conventional and MR imaging and by contrast material enhancement associated with hormonal stimulation.RN: 0 - BRCA2 protein; 0 - Genetic Markers; 0 - Neoplasm Proteins; 0 - Transcription Factors

 

 

AU:     Flegg KM, Rowling YJ

AD:     Royal New Zealand College of General Practitioners, Wellington, New Zealand.

TI:       Clinical breast examination. A contentious issue in screening for breast cancer.

SO:      Aust Fam Physician. 2000 Apr. 29(4). P 343-6; discussion 348.

MH:    Breast Neoplasms:*DI. Breast Self-Examination:*. Adult. Aged. Evidence-Based Medicine. Middle Age. Reproducibility of Results. Check Tags: Female..  Human.

AB:     BACKGROUND: Breast cancer is the commonest cancerous cause of mortality in Australian women. It is now well established that mammography is effective in reducing this mortality through screening. To this end all states of Australia have established breast cancer screening programs using mammography as their investigative modality. The purpose of this review is to determine the value of clinical breast examination as another screening tool available to general practitioners. OBJECTIVE: We identified and examined a large amount of literature relating to this subject through Medline search, the Cochrane Library and hand searching (using keywords ‘breastneoplasm’, ‘screening’, ‘breast self examination’ and ‘clinical breast examination’). The review of articles was undertaken by both authors, one of whom has extensive experience as a breast physician. DISCUSSION: Clinical breast examination for symptomatic women shows a true positive rate or sensitivity of 85%, a false positive rate of 20% and specificity of 80% for detecting the probability of cancer. The positive predictive value of this test is 81% and the negative predictive value is 84%. The sensitivity would be lower for asymptomatic women. CONCLUSION: Much has been written about screening for breast cancer. However, the absence of comprehensive studies leaves the evidence for CBE somewhat in dispute. In the absence of any harm from the procedure, it is difficult to support the currently accepted Australian evidence based guidelines which discourage the practice of CBE. It would seem more prudent given the disagreement in the literature and the acceptability of CBE to both GPs and patients to consider that there is value in using CBE as a screening tool.

 

 

AU:     Macmillan RD

AD:     Professorial Unit of Surgery, City Hospital, Nottingham, UK.

TI:       Screening women with a family history of breast cancer-results from the British Familial Breast Cancer Group.

SO:      Eur J Surg Oncol. 2000 Mar. 26(2). P 149-52.

MH:    Breast Neoplasms:*DI/EP/*GE. Adult. Great Britain:EP. Incidence. Middle Age. Prevalence. Check Tags: Female..  Human.

AB:     AIMS: To determine the efficacy of screening women under age 50 with a significant family history of breast cancer. METHODS: Results from 22 Breast Units in the UK identified as being able to provide data were surveyed and pooled through regional data managers or consultant breast specialists. RESULTS: Data relating to 8783 women screened and 9075 woman years of follow-up was analysed. Cancer incidence was 11.3/1000/year. The rate of cancer detection was 4. 78/1000 at prevalent screening and 4.52/1000 at incident screening. Median age at diagnosis was 43 years. Interval cancers presented at a rate of 2.45/1000. Comparison with the National Health Service Breast Screening Programme for women aged 50-64 revealed a similar rate of cancer detection and a similar incidence of ductal carcinoma in situ. The pathological features of screen-detected cancers in this study strongly suggest that prognosis for these women is more favourable than if they had presented symptomatically. CONCLUSIONS: This study provides evidence to suggest that screening young women with a significant family history of breast cancer is effective and that a survival benefit can be expected. As a result the British Familial Breast Cancer Group proposes a coordinated prospective observational study. Copyright 2000 Harcourt Publishers Ltd.

 

 

AU:     von Bяulow B

AD:     Danmarks Natur og Laegevidenskabelige Bibliotek, Kobenhavn.

TI:       [Psychological consequences of breast cancer screening among healthy women]

SO:      Ugeskr Laeger. 2000 Feb 21. 162(8). P 1053-9.

MH:    Breast Neoplasms:DI/*PX. Mammography:*AE/*PX. Mass Screening: AE/MT/*PX. False Negative Reactions. False Positive Reactions. Questionnaires. Check Tags: English Abstract..  Female..  Human..  Male.

AB:     The number of healthy women undergoing screening for cancer is very large. It is therefore important to know about the psychological consequences of screening. The literature for this review was found by searching in national and international databases and reading lists of references. This review finds that both women with negative test results and women with false positive test results report on psychological consequences such as fear and raised anxiety, depression, impaired working capacity, reduced self-esteem and self-confidence, as well as effects on their relationship to other people. They also report on physical symptoms such as impaired sleep or appetite. This review suggests that methods other than psychometric questionnaires would offer more knowledge on the subject and that future research should concentrate on those women experiencing serious psychological effects of screening.

 

 

AU:     Olsen O, Gotzsche PC

AD:     Nordic Cochrane Centre, Rigshospitalet, Kяopenhamn.

TI:       [There is something wrong in the studies of mammography! No support for the conclusions on benefits of breast cancer screening]

SO:      Lakartidningen. 2000 Jan 26. 97(4). P 286-7.

MH:    Breast Neoplasms:MO/PC/*RA. Mammography:*. Mass Screening:*. Evidence-Based Medicine. Meta-Analysis. Randomized Controlled Trials. Check Tags: Comparative Study..  Female..  Human.

 

 

AU:     Gotzsche PC, Olsen O

AD:     Nordic Cochrane Centre, Rigshospitalet, Department 7112, Copenhagen, Denmark. p.c.gotzsche@cochrane.dk

TI:       Is screening for breast cancer with mammography justifiable?

SO:      Lancet. 2000 Jan 8. 355(9198). P 129-34.

MH:    Breast Neoplasms:*DI/MO. Mass Screening:*. Canada. Research Design. Survival Rate. Sweden. Check Tags: Female..  Human..  Support, Non-U.S. Gov’t.

AB:     BACKGROUND: A 1999 study found no decrease in breast-cancer mortality in Sweden, where screening has been recommended since 1985. We therefore reviewed the methodological quality of the mammography trials and an influential Swedish meta-analysis, and did a meta-analysis ourselves. METHODS: We searched the Cochrane Library for trials and asked the investigators for further details. Meta-analyses were done with Review Manager (version 4.0). FINDINGS: Baseline imbalances were shown for six of the eight identified trials, and inconsistencies in the number of women randomised were found in four. The two adequately randomised trials found no effect of screening on breast-cancer mortality (pooled relative risk 1.04 [95% CI 0.84-1.27]) or on total mortality (0.99 [0.94-1.05]). The pooled relative risk for breast-cancer mortality for the other trials was 0.75 (0.67-0.83), which was significantly different (p=0.005) from that for the unbiased trials. The Swedish meta-analysis showed a decrease in breast-cancer mortality but also an increase in total mortality (1.06 [1.04-1.08]); this increase disappeared after adjustment for an imbalance in age. INTERPRETATION: Screening for breast cancer with mammography is unjustified. If the Swedish trials are judged to be unbiased, the data show that for every 1000 women screened biennially throughout 12 years, one breast-cancer death is avoided whereas the total number of deaths is increased by six. If the Swedish trials (apart from the Malmяo trial) are judged to be biased, there is no reliable evidence that screening decreases breast-cancer mortality.

 

 

AU:     De Koning HJ

TI:       Breast cancer screening; cost-effective in practice?

MH:    Breast Neoplasms:EP/MO/*PC. Mass Screening:*EC. Aged. Appointments and Schedules. Computer Simulation. Cost-Benefit Analysis. Costs and Cost Analysis. Delivery of Health Care:EC. Europe:EP. Great Britain:EP. Health Policy. Health Resources. Health Status. Mammography. Middle Age. Models, Economic. Netherlands:EP. Outcome Assessment (Health Care). Quality of Health Care. Quality Assurance, Health Care. Survival Rate. Total Quality Management. Check Tags: Comparative Study..  Female..  Human.

AB:     The main aim of national breast screening is a reduction in breast cancer mortality. The data on the reduction in breast cancer mortality from three (of the five) Swedish trials in particular gave rise to the expectation that the Dutch programme of 2-yearly screening for women aged 50-70 would produce a 16% reduction in the total population. In all likelihood, many of the years of life gained as a result of screening are enjoyed in good health. According to its critics the actual benefit that can be achieved from the national breast cancer screening programmes is overstated. Considerable benefits have recently been demonstrated in England and Wales. However, the fall was so considerable in such a relatively short space of time that screening (started in 1987) was thought to only have played a small part. As far as the Dutch screening programme is concerned it is still too early to reach any conclusions about a possible reduction in mortality. The first short-term results of the screening are favourable and as good as (or better than) expectations. In Swedish regions where mammographic screening was introduced, a 19% reduction in breast cancer mortality can be estimated at population level, and recently a 20% reduction was presented in the UK. In countries where women are expected to make appointments for screening themselves, the attendance figures are significantly lower and the quality of the process as a whole is sometimes poorer. The benefits of breast cancer screening need to be carefully balanced against the burden to women and to the health care system. Mass breast screening requires many resources and will be a costly service. Cost-effectiveness of a breast cancer screening programme can be estimated using a computer model. Published cost-effectiveness ratios may differ tremendously, but are often the result of different types of calculation, time periods considered, including or excluding downstream cost. The approach of simulation and estimation is here the same for all countries. The effects of a breast-screening program depend on many factors, such as the epidemiology of the disease, the health care system, costs of health care, the quality of the screening programme and the attendance rate. The estimated CE-ratio ranges from 2650 euros per life-year gained in Navarra to 9650 in Germany. Although relatively low incidence levels expected, the CE-ratio in Navarra is most favourable probably due to a relatively unfavourable clinical stage distribution before screening and the increasing incidence. The UK has a screening situation that is almost similar with the Netherlands. Therefore, the CE-ratios of both countries are comparable. The differences between countries make it impossible to set up one uniform screening policy. The theoretical outcomes of the benefit that can be achieved are generally from small-scale trials involving a limited number of experts, persons examined, and areas. On a national scale, with hundreds of professional practitioners, it can be expected to be more difficult to attain uniform quality. Continuous quality control, monitoring and evaluation are therefore crucial.

 

 

AU:     Sadler GR, Wang K, Wang M, Ko CM

AD:     UCSD Cancer Center, La Jolla, California, USA.

TI:       Chinese women: behaviors and attitudes toward breast cancer education and screening.

SO:      Womens Health Issues. 2000 Jan-Feb. 10(1). P 20-6.

MH:    Attitude to Health:*EH. Breast Neoplasms:*DI/*EH. Health Education: OG/*SN. Mass Screening:*PX/SN. Adult. Aged. Aged, 80 and over. Asian Americans. China:EH. Cultural Characteristics. Health Surveys. Middle Age. Sampling Studies. United States. Check Tags: Female..  Human..  Support, Non-U.S. Gov’t..  Support, U.S. Gov’t, P.H.S..

AB:     A study eliciting Chinese Women’s Attitudes and behaviors toward breast cancer screening to identify and overcome barriers to providing access to health promotion information.

 

 

Palliative Care for Terminal Cancer Patients / Палиативни грижи за терминално болни от рак

 

AU:     Bolmsjяo I

AD:     Department of Medical Ethics, Lund University, Sweden.

TI:       Existential issues in palliative care—interviews with cancer patients.

SO:      J Palliat Care. 2000 Summer. 16(2). P 20-4.

MH:    Adaptation, Psychological:*. Neoplasms:*PX. Palliative Care:*. Aged. Aged, 80 and over. Freedom. Guilt. Interpersonal Relations. Middle Age. Self Concept. Sweden. Check Tags: Female..  Human..  Male.

AB:     A minority of terminally ill patients achieve a peaceful death. Many factors, including existential distress, contribute to the emotional disquiet of patients. This study focuses on the reactions of terminally ill cancer patients to questions concerning existential issues within the themes of meaning, relations, autonomy, guilt, dignity, and communication. The results of this study indicate that patients experience a number of problems dealing with existential issues, consider these questions important, and wish to be able to discuss these types of questions with someone.

 

 

AU:     Cantwell P, Turco S, Brenneis C, Hanson J, Neumann CM, Bruera E

AD:     Edmonton Regional Palliative Care Program, University of Alberta, Canada.

TI:       Predictors of home death in palliative care cancer patients.

SO:      J Palliat Care. 2000 Spring. 16(1). P 23-8.

MH:    Home Nursing:*. Neoplasms:*NU. Palliative Care:*. Terminal Care:*. Aged. Alberta. Death. Logistic Models. Odds Ratio. Prospective Studies. Check Tags: Female..  Human..  Male.

AB:     With recent changes in health care there is greater emphasis on providing care at home, including the support of families to enable more home deaths. Since a home death may not be practical or desirable in every family situation, there is a need for an objective way to assess the viability of a home death in each individual family situation. The purpose of this study was to describe the relative role of predictors of home death in a cohort of palliative care patients with advanced cancer. A questionnaire was created as a means of assessing the viability of a home death. Five questions were included. Ninety questionnaires were administered by home care coordinators. A follow-up questionnaire was administered to record the place of death. Of the 73 evaluable patients, 34 (47%) died at home and 39 (53%) died in hospital or hospice. The desire for a home death by both the patient and the caregiver, support of a family physician, and presence of more than one caregiver were all significantly associated with a home death. Logistic regression identified a desire for home death by both the patient and the caregiver as the main predictive factor for a home death. The presence of more than one caregiver was also predictive of home death. The questionnaire is simple and, if our results are confirmed, it can be used for predicting those who will not have a home death.

 

 

AU:     Merminod T, Zulian GB

TI:       Diagnosis of venous thromboembolism in cancer patients receiving palliative care [letter]

MH:    Neoplasms:*CO. Thromboembolism:CO/*DI. Palliative Care. Check Tags: Human.

 

 

AU:     Jenkins CA, Schulz M, Hanson J, Bruera E

AD:     Division of Palliative Medicine, University of Alberta, Edmonton, Alberta, Canada.

TI:       Demographic, symptom, and medication profiles of cancer patients seen by a palliative care consult team in a tertiary referral hospital.

SO:J Pain Symptom Manage. 2000 Mar. 19(3). P 174-84.

MH:    Neoplasms:EP/*TH. Palliative Care:*. Adult. Aged. Aged, 80 and over. Alberta:EP. Analgesics, Opioid:TU. Drug Therapy. Middle Age. Referral and Consultation. Retrospective Studies. Socioeconomic Factors. Check Tags: Female..  Human..  Male.

AB:     In this retrospective study, the charts of 100 consecutive cancer patients who had been referred to a palliative care consult team within a tertiary acute care hospital were reviewed. Demographic characteristics, including reason for admission and disease status upon admission, length of stay, and discharge and admission location, were recorded. Symptom acuity, cognitive status, and risk for substance abuse were evaluated. Medications before and after the consult were tabulated and compared to recommended medications; compliance with the recommendations was assessed. Five patients were not palliative at the time of the consult. Only 46/95 (48%) were known to have untreatable cancer at the time of their admission. The CAGE questionnaire for alcoholism and the Mini-Mental State Questionnaire (MMSQ) were abnormal in 19/78 (24%) and 40/91 (44%), respectively. The most intense symptoms, as measured by the 100-mm scales of the Edmonton Symptom Assessment Scale (ESAS) were fatigue (72 +/- 24), appetite (60 +/- 32), and well-being (50 +/- 29). Eighty-nine of the 95 patients were living at home prior to admission and 34/95 were able to return home. Twenty died during hospitalization, 23 were transferred to a palliative care unit, and the remaining 18 were discharged to another hospital or long-term care. The patient’s physician complied with the palliative care consult team’s recommendation in 122/137 cases (89%).

 

 

AU:     Osse BH, Vernooij-Dassen MJ, de Vree BP, Schadяe E, Grol RP

AD:     Center for Quality of Care Research (WOK), University of Nijmegen, The Netherlands.

TI:       Assessment of the need for palliative care as perceived by individual cancer patients and their families: a review of instruments for improving patient participation in palliative care.

SO:      Cancer. 2000 Feb 15. 88(4). P 900-11.

MH:    Family:*. Needs Assessment:*. Neoplasms:PX/*TH. Palliative Care:*. Patient Participation:*. Patient Satisfaction. Psychometrics. Questionnaires. Check Tags: Human..  Support, Non-U.S. Gov’t.

AB:     BACKGROUND: Palliative care should fit the needs of individual cancer patients and their families. Instruments can help to improve needs assessment. This review evaluates questionnaires for the systematic assessment of needs experienced by individual cancer patients for help, care, or support, as well as the needs of their family members. METHODS: The MEDLINE and PsycLIT data bases were searched systematically. Questionnaires were evaluated by reviewing their contents and estimating their validity, reliability, and feasibility for use in caregiving practice. RESULTS: Analysis of the 471 articles identified from the searches yielded 9 questionnaires for the assessment of patients’ needs and 6 questionnaires for the assessment of family members’ needs. Most of these instruments were carefully constructed; their validity and reliability were satisfactory and well documented. However, in most questionnaires the needs for care were confounded by satisfaction with care, and the problems experienced by patients. Only one questionnaire for patients specifically addressed the need for help; none for family members was so specific. Data on the feasibility of questionnaires for use in regular care were scarce. Issues frequently omitted were spiritual issues, the personal needs of family members, and the continuity of care. CONCLUSIONS: None of the instruments the authors found was complete for all dimensions of palliative care. Most instruments were constructed for research purposes and had not been tested for use in practical care. Further development of practical instruments based on a theoretical concept of needs assessment seems necessary. The feasibility of instruments for use in practical caregiving and their effects on the quality of care needs further research.

Copyright 2000 American Cancer Society.

 

 

AU:     Van den Eynden B, Hermann I, Schrijvers D, Van Royen P, Maes R, Vermeulen L, Herweyers K, Smits W, Verhoeven A, Clara R, Denekens J

AD:     Centre for General and Family Medicine, Universitaire Instelling Antwerpen, Universiteitsplein 1, University of Antwerp, Wilrijk, Belgium. vandeneynden@glo.be

TI:       Factors determining the place of palliative care and death of cancer patients.

SO:      Support Care Cancer. 2000 Jan. 8(1). P 59-64.

MH:    Attitude to Death:*. Neoplasms:*PX. Palliative Care:*. Patient Transfer:*. Adult. Aged. Aged, 80 and over. Cancer Care Facilities. Chi-Square Distribution. Home Care Services. Hospices. Middle Age. Odds Ratio. Questionnaires. Retrospective Studies. Terminal Care. Check Tags: Female..  Human..  Male..  Support, Non-U.S. Gov’t.

AB:Factors determining the place of palliative care and death were studied by interviewing 40 patients using a semi-structured questionnaire. The 86 interviews assessed showed that both emotional and somatic factors played a part in the determination of whether patients were transferred and of their place of death. Emotional factors were mentioned in 41% as being of importance, and physical factors in 32%. Material and financial factors are probably underestimated owing to the methodology.

 

 

AU:     von Gunten CF, Martinez J

AD:     Center for Palliative Studies, San Diego, CA 92103-1407, USA.

TI:       Role of palliative medicine in cancer patient care.

SO:      Cancer Treat Res. 2000. 102P 65-76.

MH:    Ethics, Medical:*. Neoplasms:*TH. Palliative Care:*. Hospice Care. Interprofessional Relations. Patient Care Planning. Check Tags: Human.

 

 

AU:     Wright CJ

TI:       Effect of curative versus palliative resection for stage III pancreatic cancer patients. 1999; 44(4): 231-5 [letter]

SO:      J R Coll Surg Edinb. 1999 Dec. 44(6). P 410-1.

MH:    Palliative Care:*. Pancreatic Neoplasms:PA/*SU. Pancreaticoduodenectomy: *. Patient Selection. Prognosis. Treatment Outcome. Check Tags: Human.

 

 

Инициатива за по-добро здраве – Габрово: Проекти в ход

 

Здравно-образователна програма и изграждане на групи за взаимопомощ и обучение за инвалиди от гр. Габрово

Стефка Рачева

Проектът е разработен за членовете на клуба на инвалидите гр.Габрово - 800 инвалиди от всички възрасти и заболявания.

Сред тях бе проведена анкета за желанията им в каква група за взаимопомощ желаят да участват. След обработване на данните от анкетата се изградиха проблемни групи: спортна дейност за млади и възрастни; певческа група; група за културни занимания по лични предпочитания - риболов; младежка секция; хора със сродни съдби; общообразователни; информационни; по заболявания: диабет, сърдечно-съдови, стомирани, костно-ставни, общи, психически.

Проведени бяха 11 срещи на различни групи. В групите участват от 20 до 70 човека.

Проектът породи нови идеи за дейности. Вече започнатите дейности ще продължат и след приключване на проекта.

 

 

Отдиференциране на спешните от рутинните клинично-лабораторни изследвания и постигане на добра колаборация между лаборатория и отделения в МБАЛ - АД- гр. Габрово

Мариана Станкова, Анелия Великова

Изработена бе листовка, в която са включени обем спешни клинично-лабораторни изследвания; основни правила и изисквания на вземане биологичен материал за клинично-лабораторни изследвания.

Проведена бе лекция на тема: “Отдиференциране на спешните от рутинните клинично-лабораторни изследвания”. Проведен бе колегиум в клинична лаборатория за принципа и начина на работа. Изготви се “методично указание” и се разпространи до всички отделения.

Главният лекар на болницата д-р Паралчев заедно с ендокринолога д-р Куртев изготвиха и разпространиха “указания относно по-рационалното използване на изследването кръвна захар. Главния лекар издаде заповед, изготвена със съдействието на анестезиолозите и клинична лаборатория, считана от 19.02.2001г. за минимални изследвания за планови операции на болни, с цел избягване на повторение на изследванията, направени по искане на семейния лекар или ЦСМП.

Постигна се добра колаборация между лабораторията и отделенията в МБАЛ-АД, и се подобри ефективността на работата в лабораторията. Икономически ефект: броят на спешните изследвания е намален средно с 1300, и са  спестени средно 5 – 10 000 лева на месец след стартирането на проекта.

 

 

Програма за обучение, разясняване на населението нуждите от хоспис за обгрижване на тежко болни, самотни стари хора, и тежко болни в терминален стадий в Габровска
област

д-р Н. Дамянова

Проведено бе обучение на медицински сестри по следните теми: “Лечение и рехабилитация на болни с мозъчен инсулт в домашна обстановка”; “Ролята на медицинската сестра от хосписа при оказване на палиативни грижи в дома на болния”; “Сестрински интервенции за засилване надеждата на болните от рак”; “Профилактика на декубитус” с лектори д-р Антония Колева, д-р Христина Георгиева и м.с. Любка Димитрова.

Издадени бяха и разпространени 50 листовки и статии в местни вестници. Чрез Интернет получихме материали за хоспис с подробно описание за дейността на различни хосписи във Великобритания и ги предадохме на хоспис “Здраве” – Габрово.

Предстоящи мероприятия: посещения на други хосписи в страната с цел обмяна на опит за оборудване на бъдещата сграда, включване на хоспис “Здраве” в международната верига и издаване на диплянки след завършване на ремонта на сградата на хосписа за онагледяване условията в него. 

Листовките и връзките с Интернет са осигурени от областната управа на Габрово.

 

 

Подобряване качеството на проследяване и терапия на прекарали остър инфаркт на
миокарда

д-р Мирослав Стоянов

За постигане целите на проекта бяха включени още двама лекари, работещи в кардиологично отделение.

До 30.04.2001г. бяха регистрирани и включени необходимите 50 болни, на които бе проведено Холтер ЕКГ изследване. Регистрирани бяха 3 болни със злокачествени ритъмни нарушения и 4 болни със слединфарктна миокардна исхемия, при които се наложи корекция на лечението.

Трудности: отдалечеността на местоживеенето на някои от включените в програмата болни.

Предстои проследяване на болните за период от 1 година и съпоставяне смъртността със същия брой болни, дехоспитализирани от МБАЛ след 01.11.1999г

 

 

Подобряване на хигиената, частично залесяване и повишаване екологичната култура на студентите на територията на студентски общежития на Технически университет – гр. Габрово

Андриан Василев

През януари 2001 г. започнахме с обработване и подготовка на материалите, предназначени за издаване на образователно-информационна брошура “Екология за всеки”. През февруари бе подготвена анкета и организирано почистване на района около общежитията.

През март бяха засадени 25 бр. дръвчета и храсти /рози/. Отпечатаха се образователно-информационната брошура ”Екология за всеки анкета и бяха разпространени сред студентите. 30 души доброволци, студенти, обхванаха 1000 в общежитията.

Резултати: подобри се хигиената и околната среда около общежитията и екологичната култура сред студентите. С доброволния труд на 30 студенти се осъществи успешната реализация на проекта като за в бъдеще ще продължи поддържането на постигнатото.

 

 

Здравно-образователна програма за намаляване хоспитализациите на болни след преживян инфаркт на миокарда

Иванка Младенова

Обхванати  да 50 пациенти и са обучени по време на престоя им в отделението. На всеки болен е дадена книжка “Инфаркт на миокарда – училище за пациенти”, както и индивидуален дневник за проследяване на жизнените параметри в домашни условия. В дневника на всеки болен бяха вписани индекс на телесната маса /ИТМ/, ниво на холестерола и рисковите фактори (диабет, високо кръвно налягане, наследственост, тютюнопушене).

Издадени бяха и брошури: “Диета, понижаваща нивото на липидите”; “Контрол на теглото зависимост от ИТМ”

По проекта работиха 3 медицински сестри и един лекар. Болните бяха посетени по домовете им за отчитане на умението им за водене на индивидуалните дневници. Предстои отчитане на крайния резултат след 1 година в процент дали е постигнато намаляване на хоспитализациите.

 

 

Проект за адекватно оборудване и работа на бронхологичен кабинет

д-р Красимир Дончев

Реализирано е обучение на една бронхологична сестра и един лекар в курс “Спешни състояния в пулмологията”. Закупени бяха важни консумативи, изработени и отпечатани бланки за описание. Намерени бяха спонсори. Прегледани 8 пациента с тумор; 4 – оперирани. Предстои ремонт на кабинета и намиране на спонсори за закупуване на апаратура. Това е проект, който изисква значителни средства. Все по-голям обем манипулации да бъдат проведени в бронхологичен кабинет – лазер терапия, стентове. Развитие на гръдна хирургия в болницата.

 

 

Програма за проследяване и обучение на 40 пациента след прекаран остър миокарден инфаркт

Ганка Димитрова

Обхванати бяха 40 пациенти, разпределени в 4 групи по 10 човека. Проследяват се два пъти месечно следните показатели: тегло, пулс, дишане, RR, тест с натоварване. Реализирано обучение със разговори на здравна тематика и предоставени подходящи здравно-просветни материали.

Предстои създаване условия за по-добра мотивация на болните; реализиране възможност за ЕКГ контрол в отделението, както и проследяване в продължение на една година и отчитане на ефективността на проекта на базата на броя на хоспитализациите  преди стартирането но проекта.

 

 

Здравно-образователна програма за ранно откриване рака на женската гърда и психо-терапевтична помощ за жените с този проблем

д-р Станка Борисова

Подготви се и се отпечата листовка – 1500 бр., съдържаща способите за самоизследване на женската гърда. Изнесени са десет лекции за същността на рака на женската гърда и профилактиката за ранното му откриване. По време на лекциите се проведе и обучение за самоизследване: четири от лекциите се проведоха в средни училища на града с последните класове, а шест - в трудови колективи с предимно женски състав. По време на лекциите се раздаваха листовки.

По време на Националната кампания за борба с рака на женската гърда се разнесоха по пощенските кутии 1000 листовки. По местната телевизия по време на същата кампания се информира обществеността за подкрепата, оказана от фондация “Драйфус” по този проект. Не се осъществи психо-терапевтична помощ за жените, претърпели мамектомия поради липса на средства за заплащане на психотерапевти.

 

 

Създаване на сестринско звено за здравни грижи по домовете на терминално болни

Снежана Георгиева, Галя Петрова

Обслужени бяха 30 терминално болни. Оказани медицински услуги и морална подкрепа на пациентите и техните близки по домовете. Концентриране върху борбата с болката и подобряване качеството на живот. Групата, с която беше реализиран този проект – медицински екип от 10 бр. медицински сестри.

Планове за бъдещето на проекта:

1. Създаване на Хоспис – с привличане на общински ръководители и ръководители на ЗОК като одобрение и финансова поддръжка.

2. Свързване с ръководството на МБАЛ –АД гр. Габрово.

3. Комуникация със Социални грижи и Първична здравна помощ.

4. Гласност сред общността чрез медиите, издаване на брошури.

 

 

Популяризиране на дейността по програма за превенция на самоубийствата

Елиза Ковачева

Изготвен бе плакат, информиращ обществеността за Програмата на Министерството на здравеопазването: “Профилактика на самоубийствата в Република България” и дейностите на социалните организации за превенция на суицидното поведение и разпространението му в правителствени и неправителствени организации и подходящи за целта места.

С известният български плакатист Иван Богданов бе изработен проект и плакат, като се осигуриха и още средства от спонсори за издаване на плаката в достатъчен тираж. Проектът е свързан с проект на ХЕИ –Габрово за “Събиране на достоверна информация за извършени суицидни опити и намерения за такива и причините за тях, чрез откриване и обявяване на телефонна линия “Телефон на доверието” Чрез плаката бе обявен телефонен номер, и в последствие, чрез обажданията, бе събрана информация и осъществени контакти с лица, стигнали до идеята за самоубийство. След осигуряване на средства в бъдеще плакатът ще се преиздава, тъй като програмата на МЗ е обявена от 2000 до 2006г.

 

 

Комплексна здравно-образователна програма за деца на възраст от 12 до 18 години в две учебни заведения в гр. Габрово”

Христина Панова

Обхванати са 529 деца, техните родители и учители. Проведена е анкета в училищата с цел да се проучат възрастовите граници на учениците, който пушат, употребяват алкохол, наркотици и колко от децата са подлагани на насилие. Проведени са 18 беседи по тези проблеми.

Изработени са брошури, които се раздадоха на всички ученици, родители и учители. Сформирани са два клуба “Дебати”. Издирени са рискови деца, с които се работи и говори непрекъснато. Изработен е тест за ученици, пушачи.

Засне се филм по проблемите на наркоманията, тютюнопушенето, алкохолизма, СПИН и насилие, който е със здравно-просветна насоченост и след приключването му ще бъде излъчен по кабелната телевизия и във всички училища.

Предстои да се организира тренинг по всички тези проблеми, на който ще участват ученици от 12 до 18 години от І ОУ”Ран Босилек” и НАГ “Васил Априлов” на тема: Здрави деца – светло бъдеще”. Целта на тренинга е да се изработят нагледни материали, който ще бъдат поставени в училищата като плакати, кутии за неудобни въпроси, снимки и др.

Почти всички анкетирани ученици взеха участие в проведената АНТИ-СПИН кампания на 17.05.2001 г. и на 31.05.2001 г. – Ден без тютюнев дим.

 

 

Програма за социализация на децата (0-3 г.) в ДМСГД гр. Габрово

Илияна Донкова

За реализация на програмата бе създаден екип от сестри и педагог за всяка група деца от дома. Всяка сестра отговаря за няколко деца конкретно.

Закупени са тетрадки за всяко дете, в които се отчита всяка промяна във физическото и психичното състояние на децата. В тази връзка бяха отпечатани детски албумчета, наречени “Бебешки паспортчета”, които включват най-важните неща от горните тетрадки като първа усмивка, първо зъбче и т.н., а също така и проведено лечение, имунизации и т.н. Те ще се предоставят на родителите при осиновяване на детето.

За по-големите деца са закупени блокчета за рисуване, гланцови блокчета, моливи и др., за занимаване на децата, когато не ходят на детска градина или ясла. Ползата от проекта се изразява в това, че децата започват да се развиват значително по-бързо и показателите се оценяват по таблица за коефициент на развитие. Трябва да се продължи да се работи в тази насока  и да се помисли за формиране на клуб деца – приятели на децата от ДМСГД.

 

 

Събиране на достоверна информация за извършените суицидни опити и намерения за такива, установяване на причините за тях и откриване на телефонна линия, работеща денонощно “Телефон на доверието”

д-р Севдалина Йотева

Започнахме с откриване на телефонна линия, работеща денонощно “Телефон на доверието” и откриване на електронна поща. Посетени бяха всички общопрактикуващи лекари и лекари специалисти от ДКЦ и многопрофилните болници в областта, на които бяха раздадени анкетни карти за събиране информация за всеки суициден опит и причините за него. Проведена бе работна среща с Обществената коалиция за борба със самоубийствата, на която присъства националният координатор. Събиране на обратна информация, систематизиране и анализиране на данните и бързо отреагиране на всеки сигнал или опит за самоубийство, чрез екипи на обществената коалиция.

За трите месеца са попълнени 12 карти, спасени са 9 души. Помогнато е на 21 човека да преодолеят кризата.

Работихме с Обществена коалиция от 32 правителствени и неправителствени организации; Медийния съвет –София; списание “Етос”, писателя Димитър Коруджиев, които са спонсорирали проекта със 120 броя на “Всичко е история” – сборник есета, подходящи за повишаване на духа и справяне със кризисната ситуация и 2 два броя на списание “Етос” – 240 екземпляра. Подготвя се предаване по националната телевизия за проблема, а в издание на списание ”Етос” проф. Д. Свиленов ще постави основно този проблем.

Нерешен остава проблемът за необходимостта от консултация – първична – от клиничен психолог (психоаналитик) на пациентите ни. Такъв работи по програмата ни безплатно – три месеца, но вече е освободен, съкратен от Диагностично консултативен център и няма психолог, към който да се насочат отчаяните и объркани хора, попаднали в кризисна ситуация. Досега са обхванати 21 души, на които е оказана съответна помощ и, въпреки предстоящите трудности, програмата трябва да продължи.

 

 

Ранна профилактика на посттравматична остеопороза при жени в активна трудова
възраст.

д-р Дора Чернева

В програмата са участвали 19 жени на възраст от 30 до 60 г. (3 жени на 60г.) Локализация на травмата: 17 жени – горен крайник; 2 жени – долен крайник.

Шест пациентки са започнали комплекса от мероприятия по време на имобилизацията с гипс. Останалите 13 – непосредствено след сваляне на гипсовата имобилизация.

Работата с всяка жена е била индивидуална, включваща: двигателен режим; указания за хранителен режим; физиотерапевтични процедури. Продължителността на индивидуалната програма при всяка жена е била средно 15 работни дни. При две жени е проведен втори курс след един месец, при една жена – 3 курса. Наблюдавани показатели: наличие на болка; наличие на ограничена функция на крайника, затруднено самообслужване и  изпълнение на трудова дейност. Жените са насочвани от колеги физиотерапевти и ортопеди.

Работата по програмата е извършвана в кабинета по физиотерапия и рехабилитация – ІІ база на ДКЗ от д-р Чернева и екип от кинезитерапевти и рехабилитатори и двигателен режим в дома.

 

 

Обучение на медицински сестри, рехабилитатори, лаборанти, акушерки и фелдшери в начални компютърни умения.

Нели Тодорова

Обучени са 70 медицински сестри, рехабилитатори, лаборанти, акушерки и фелдшери.

Компютъризирани са прием на болните, кодиране на заболявания и административни дейности.

Предстои: обучение по английски език и Интернет знания; компютъризиране на дейностите в отделенията.

 

 

Намаляване на процента на децата с гръбначни изкривявания в ОУ “Н. Рилски” –
Габрово

Петя Тошкова

Сред учениците от училището се наблюдава висок процент гръбначни изкривявания (над 30%). Училището е с доста остаряла материална база. Липсваха подходящи пособия и уреди за изправителна физкултура. Именно поради тази причина се наложи средствата по проекта да бъдат изразходвани за дооборудване на физкултурния салон, след консултация с кинезитерапевт и лекар.

Първичният преглед бе осъществен от д-р Стефанова, детски лекар – за установяване степента на гръбначните изкривявания. Картотекирани са децата с неправилна стойка и деца с І и ІІ степен на гръбначни изкривявания. Провеждат се системни занятия с картотекираните деца 3 пъти седмично като се сформираха 2 групи в начална училищна възраст и 1 група средна степен.

В часовете по физическо възпитание се работи системно като се отделят по 15 минути от часа за физически упражнения, подходящи за деца с гръбначни изкривявания. Проведени са здравни беседи от медицинското лице на училището – сестра Маргарита Генева, с цел повишаване здравната култура на учениците. Работата по програмата ще продължи до края на учебната година (15.06.2001г.), а в началото на следващата учебна година ще се проведе медицинският преглед, който ще установи с какъв процент е намалял броят на децата с гръбначни изкривявания.

Събран е снимков материал и дипляна за отчитане дейността по проекта през годината. Надяваме се, че този пилотен проект ще се превърне в една дългосрочна програма, която ще допринесе много за намаляване процента на децата с гръбначни изкривявания.

 

 

Програма за превенция на тютюнопушенето сред деца на възраст от 8 до 15 години в ОУ “Н.Рилски”- Габрово

Пепа Йотева

В ОУ”Н. Рилски” – Габрово стартира програма за превенция на тютюнопушенето, която обхвана всички ученици от 8 до 15 години. Учениците бяха разделени по възрастови групи: І група – 8-10 години; ІІ група – 11-15 години.

Изготвена бе и проведена встъпителна анкета с ученици, което е представителна извадка за училището.

Проведоха се два конкурса – литературен и конкурс за рисунка на тема: “Тютютнопушене или здраве – изберете сами”. Учениците колективно гледаха и обсъдиха филм на тема”Тютютнопушене”.

С ученици от начална степен ІІ – ІV клас бяха проведени ролеви игри и представени игрови ситуации, свързани с темата. С ученици от средна степен се проведоха тренинги за превенция на тютюнопушенето. Учениците се включиха в дискусионни групи и бяха привлечени като фасилитатори от педагогическия съветник, при работата с по-малките ученици. На 31.05.2001 г. бе открита изложба в Националния музей на образованието /Априловската гимназия/,  на която малките и големите ученици изложиха своите творби. Най-добрите произведения на децата от литературното и художествено творчество бяха наградени. Поради големия интерес и много рисунки по темата, раздадохме и поощрителни награди.

През м. юни проведохме заключителен тест за проверка на нивото на информираност и знанията на учениците след целогодишната работа по проекта.

 

Резултати от проведен тест за изходно ниво на тема ,,Тютюнопушене”

 

За проверка на здравната култура и нивото на информираност на учениците, бе проведен тест на тема ,,Тютюнопушене” със 155 ученика от училището.

Резултатите показват следното:

·       86,8% ученика посочват,че тютюнопушенето оказва най-вредно въздействие върху сърцето.

·       85,9% отговарят вярно на 2-pи въпрос,че пушенето е вредно преди всичко за кръвоносните съдове.

·       82,3%  от анкетираните отговарят вярно на въпроса “Колко отровни вещества се съдържат в особено голяма концентрация в тютюневия дим  - над 100.

·       96% отговарят,че двете вещества, които се съдържат в особено голяма концентрация в тютюневия дим са катран и никотин.

·       За организма никотинът се явява нервна отрова е правилният отговор,който дават  99,7% от анкетираните ученици.

·       Най-често в организма настъпва смущение в кръвоснабдяването, според 82,6% от анкетираните ученици

·        сърдечносъдовите заболявания са тези, които се причиняват  предимно от никотина според 82,3% анкетирани ученици.

·       На въпроса какво означава повишена смъртност на пушачите със 10% , правилен отговор дават 88,6% - на 100 непушачи умират през същото време 200 пушачи.

·       Катранът действа преди всичко на дихателните пътища, отговарят правилно 78,3%  анкетирани

·       78,6% отговарят,че умират пет пъти повече пушачи от хроничен бронхит и разширение на белите дробове .

·       От тютюнев катран се причинява най-вече белодробен рак ,са отговорили правилно 78,3%  анкетирани , а дали е доказано това 78,3 отговарят,че пушачите умират 10 пъти по-често от непушачите.

·       93%  анкетирани отговарят,че непушачът живее по-дълго от пушача.

·       На  въпроса все едно ли е да се пуши цигара, пура и лула , 58% отговарят,че цигарата е най-вредна .

·       96% отговарят ,че колкото по-рано се започне да се пуши, толкова е по-вредно за здравето.

·       82,6% отговарят,че колкото по-вече цигари се пушат дневно , толкова по-силно се уврежда здравето.

·       Пушенето по време на бременност уврежда зародиша , според 96% анкетирани ученици

·       84,6% общо взето пушачите по-увредими от ежедневни проблеми.

Данните от теста показват, че след работата по проекта учениците имат по-задълбочени знания и информираност относно тютюнопушенето и вредата му за човешкия организъм, в сравнение с изходната проверка в началото на работата по проекта.

Анкетираните са ученици в средна училищна възраст и на този етап сме постигнали целта на програмата за превенция на тютюнопушенето. За да превърнем знанията в навик и умение за противодействие на зависимостите и натиска от страна на другите, трябва непрекъснато да работим по проблема ,,тютюнопушене”, което ще бъде гаранция за една добра здравна профилактика.

 

 

Повишаване здравната култура и информираността на учениците от ІІ ОУ на възраст 12-14 години, по отношение на алкохола, наркотиците и вредата от тях за организма.

Мая Колева

Във ІІ ОУ “Н.Рилски”- Габрово работим превантивно по програма “наркотици”. Въпреки това сме на мнение, че подрастващите разполагат с недостатъчна информация за вредата от употребата и зависимостта от алкохола и наркотиците, тъй като досега по-скоро сме давали информация на учениците за видовете наркотици и опасността им за човешкия организъм, а не сме акцентували на изграждане на умения за вземане на решение и противопоставяне при натиск на приятели и други, предлагащи наркотични вещества.

Целта на настоящия проект е повишаване на здравната култура и нивото на информираност на подрастващите, чрез въвеждане на училищна здравно-образователна програма, свързана с превенция на зависимостите – алкохол и наркотици.

Проведена е анкета с ученици от VІ – VІІІ клас (96 ученика), което е представителна извадка за училището с цел проверка на нивото на информираност по отношение на алкохола, видовете наркотици и опасността от тях за човешкия организъм. В часовете на класа педагогическият съветник и класните ръководители работиха активно, с помощта на интерактивни форми на работа с всички ученици от VІ, VІІ и VІІІ клас на тема ”Ученици от ІІ ООУ казват “Не на наркотиците”. Учениците от VІ до VІІІ клас колективно гледаха и обсъдиха филмите “Аз обвинявам” и “Омагьосаният кръг”, които бяха и повод за проведените след това дискусии на тема: “Право на избор”.

През месец април проведохме дебат с учениците от VІІ-а клас на тема”Наркотиците са болест или дезадаптирано поведение”. Учениците показаха завидни знания и бяха горещо аплодирани от съученици и учители.  

През месец май в Музея на образованието бяха изложени най-добрите рисунки от проведения конкурс за рисунка и бяха наградени победителите от двата конкурса за рисунка и литературния конкурс.

В началото на месец юни проведохме заключителен тест, който е своебразна проверка на знанията на учениците след работата по проекта.  

Дейностите по проекта са записани на видео касета. Има и богат снимков материал.

 

 

Ранна диагностика на колоректален рак

д-р Тодор Шандурков

От 01.12.2000 до 31.05.2001 са прегледани по показания за фиброколоноскопия 374 души. От тях 127 са под 60 години, т.е 43%.

При 8 от тази група (6,2%) е открит рака на колона е са насочени за лечение.

Перспектива: В МБАЛ – Габрово предстои въвеждане на тотална колоскопия в кабинета по ендоскопска диагностика след получаване на нова апаратура през  август 2001г.

 

 

Откриване на танцувални групи за профилактика и навременно коригиране на плоскостъпие и изграждане на правилна стойка при деца от 4-10 години

Ценислав Влъкненски

Договорено бе организиране на танцувални групи за профилактика на плоскостъпие на проекта в ОУ “Н. Рилски” и ЦДГ “Радост” гр. Габрово. Организиран бе координационен съвет и медицински екип – кинезитерапевт и медицински сестри.

Изработени  са 600 рекламни брошури, както и анкетни карти и помагала. Изработени бяха плантограми на 380 деца от 4-10 години (16% 4-6г.; 23% 7-10г. деца с плоскостъпие). Изнесени са две лекции пред родители и деца. Раздадени бяха рекламни и разяснителни материали на проекта. Сформирани бяха  4 групи (общо 45 деца с плоскостъпие), занимаващи се 2 пъти седмично по 1 ч. В ОУ “Н. Рилски” и ЦДГ”Радост” проектът продължава октомври, ноември, декември 2001г.

Крайните резултатите ще се отчетат през януари 2002г.

 

 

Gabrovo Initiative Projects in Action

(brief reports)

 

Health Education and setting up support groups for disabled people in Gabrovo

Mrs. Stefka Racheva

The support groups included 800 disabled people in Gabrovo.

Eleven support groups (number of members ranging from 20 to 70) were set up according to the interests, ages and type of disability. Members of one group often join the meetings of other groups. Meetings were organized for each group.

The activities within the project have given rise to new ideas, and will continue after the project is completed.

 

 

Reducing the number of unnecessary emergency lab tests by improving on the collaboration between the wards and the clinical laboratory of the regional hospital in Gabrovo

Mrs. Mariana Stankova, Mrs. Anelia Velikova

A leaflet was prepared indicating the emergency tests, basic rules of collecting samples.

A talk was organized on the problem of ruling out the unnecessary tests that are carried out on an emergency basis. A training session was organized at the clinical laboratory, and a set of rules was prepared and distributed to all hospital wards.

The director of the hospital, Dr. Paralchev, and Dr. Kurtev, endocrinologist, prepared directions as to how to use the reagents to evaluate blood glucose level.

Anesthesiologists and clinical laboratory specialists prepared a set of directions as to what tests should be performed in cases of planned surgical operations. This allowed avoiding repeating tests already administered by emergency rooms and GPs.

Results: a better collaboration was achieved between the laboratory and the wards. The number of emergency tests was reduced by 1,300, and 5 to 10 thousand levs (Apr. $5,000) were saved per month.

 

 

A program for training personnel and advertising the need of a hospice on the territory of Gabrovo region to meet the needs of nursing for severely ill and lonely elderly people, and terminal patients

Dr. Nina Damyanova

Lectures and training sessions were organized for nurses on the following topics: treatment and rehabilitation of stroke patients in their homes, the role of hospice nurses in palliative care in the home, intervention of nurses to raise hope in cancer patients, prevention of decubital ulcers, with Dr. Antonia Koleva, Dr. Cristina Georgieva and Mrs. Lyubka Dimitrova as lecturers and trainers.

Leaflets were prepared and distributed, and materials were published in the local newspapers. Materials on hospice care in the UK were found in the Internet, and these materials were handed over to the hospice in Gabrovo.

We plan visits to hospices in the country, joining the hospice in Gabrovo to the international chain of hospices.

The leaflets and Internet access were provided by the governor’s office in Gabrovo.

 

 

Improvement of the follow-up and therapy for AMI patients

Dr. Miroslav Stoyanov

The project team included three doctors from the cardiology ward. Between November 1, 2000, and April 30, 2001, 50 AMI patients were registered, and underwent Holter EKG. Three patients were diagnosed with severe arrhythmias, and in four – with post-infarction myocardial ischaemia. The treatment strategy was changed in these patients.

There were problems with following the patients living too far from the hospital.

The patients will be followed up for one year, and mortality rate will be matched compared to a control group of 50 patients, discharged from the Gabrovo regional hospital after November 1, 1999.

 

 

Improving the hygiene and ecological culture if students at the technical university of Gabrovo

Mr. Andrian Vassilev

A brochure on environment protection and an inquiry were prepared in January 2001. The campus areas were cleaned.

In March, trees and bushes were planted.

Results: the hygiene is now better, and the level of knowledge of students on environment protection is higher.

 

 

Health educational program to reduce the readmissions to hospital of acute myocardial infarction patients

Mrs. Ivanka Mladenova

Fifty patients were educated during their stay at the cardiology ward. Each patient was provided with a booklet “Myocardial infarction: what should a patient know”, together with a diary with instructions how to record parameters like body mass index, cholesterol level, etc. Risk factors were described too: diabetes, high blood pressure, heredity, cigarette smoking. 

Later, patient received tow other brochures: A Diet to Reduce Lipid Levels” and “Body Weight Control”.

Three nurses and a doctor worked on the project. The patients were visited in their homes, and the diaries checked.

The final results will be checked after one year.

 

 

Improving the work in a lung disease consulting room

Dr. Krassimir Donchev

One nurse and one doctor attended a training course on emergency states in pulmology. The consulting room was provided with indispensable disposables, and brochures were prepared for the patients. Of the patients examined, 8 were diagnosed with tumors, and 4 of them were operated on.

Sponsors helped with the activities, but more are needed to renovate the room and purchase new equipment, so that the number of investigations and procedures can be increased.

 

 

A program to follow up and educate 40 acute myocardial infarction patients

Mrs. Ganka Dimitrova

The 40 patients were divided into four equal groups. For each group, weekly check ups were organized for weight, pulse rate, respiration rate, blood pressure, and reaction to physical exertion. Talks on health issues took place in the groups, and health education materials were provided.

Further efforts will be made to motivate the patients to cooperate, and find possibilities to perform EKG tests in the ward.

Assessment will be made on the basis of number of readmissions to hospital.

 

 

A Health education program for early diagnosis of breast cancer and psychological support for women after mastectomy

Dr. Stanka Borissova

A leaflet was prepared on self-examination of the breast. Ten lectures were delivered on breast cancer and the role of its early detection. During the lectures, methods of self-examination were demonstrated. Four of these lectures were with students from the upper classes of high schools, and six were in factories and organizations with predominantly female employees. Leaflets were given to all attending the lectures.

During the national breast cancer campaign, 1000 leaflets were posted to women in Gabrovo. The local television broadcasted information on the project.

Psychological support for mamectomized women could not be organized due to lack of funds.

 

 

Organizing a team to provide nursing care for terminal patients in the home

Mrs. Snezhana Georgieva, Mrs. Galya Petrova

Nursing care was provided for 30 patients in their homes. Along with medical care, the patients and their relatives were offered psychological support.

The team of 10 nurses focused on pain control and quality of life.

Future plans:

Setting up a hospice, in collaboration with the regional health insurance fund, the local government, the regional hospital in Gabrovo, social services and the primary health care.

Local media will be involved, and brochures will be prepared.

 

 

Spreading information about the suicide prevention program

Mrs. Elisa Kovacheva

A poster was prepared, informing the community about the program for prevention of suicides of the Ministry of Health, and the activities of social services within the program. The poster was sent to governmental and non-governmental organizations. Sponsors were attracted to make more copies of the poster.

The project was linked to a project of the Hygiene and Epidemiology Station in Gabrovo, the latter aiming to collect adequate information about suicide attempts and intentions. A “hot line” was opened and advertised

The calls helped establish contacts with people with suicide intentions.

Future plans include finding new sponsors for producing more posters.

 

 

A health educational program for children aged 12-18, attending two schools in Gabrovo

Dr. Christina Panova

The target group included 529 children, and their teachers and parents. An inquiry was made to collect information about the children: smoking habits and ages of smokers, alcohol use, drug use, and violation. Eighteen talks were organized with different groups on these topics.

Brochures were prepared, and given to all children, parents and teachers. Two discussion groups were organized. Risk children were identified, and specialists work with them individually. An inquiry was made to test the children’s level of knowledge on effects of smoking.

A health-education video was made, dealing with problems associated with drug use, smoking, alcohol use, AIDS and violence. The film will be shown on the local TV channels, and in all schools in Gabrovo.

A training session will be organized for children from Ran Bossilek Primary School and the National Aprilov High School. At the session, the children will prepare materials. These materials will be distributed to other schools.

Most of the children took part in the activities organized on the international anti-AIDS and anti-smoking days.

 

 

A program to improve on the integration skills of children aged 0-3 years, from an orphanage in Gabrovo

Mrs. Iliana Donkova

The activities were organized in such a way that teams including nurses and pedagogical advisors were focused on the groups formed. Each of the nurses was responsible for a couple of children.

For each child, a diary was started, in which all changes in the physiological and psychological status of the child were recorded. In the albums prepared (“baby passports”), pictures were collected – first baby tooth, first smile, etc., as well as dates of immunizations, treatment history and other such information. These diaries are meant to be handed over to given to parents who adopt the children.

For the older children who do not attend nursery schools, drawing materials and color paper were provided, to play and draw.

The results show improvement in the development of children, and this is demonstrated from the standard test for evaluation.

The activities should be continued, and contacts with children from outside the orphanage established.

 

 

Collecting information about suicide attempts and intentions, investigation of causes and starting a 24-hour hot line

Dr. Sevdalina Yoteva

The project was started with opening a hot line and providing an e-mail address.

All GPs in the region and the specialists from the diagnostic centers and the hospitals were approached, and were given questionnaires to collect information on suicide all suicide attempts. At a meeting of the Citizen’s Coalition for suicide prevention, collaboration was discussed and agreed upon in collecting information, processing and analyzing data, and approaching each case individually.

For three months, 12 questionnaires were filled in, and 9 people were saved, and 21 were helped to overcome crises.

We worked together with the Citizen’s Coalition, which has 32 member organizations – National Media Council, ETOS magazine, NGOs in Gabrovo. Mr. Dimitar Korudjiev – author of a collection of stories focused on solutions in critical life situations, donated 120 copies for the project. Two issues of ETOS magazine (240 copies) were also donated. A special video is being prepared to be broadcasted on national TV, and materials by Prof. Svilenov are to be published in ETOS magazine.

The problem that remains unsolved is that our patients cannot be given consultations by a clinical psychologist.

 

 

Early prophylaxis of post-traumatic osteoporosis in women aged 30-60

Dr. Dora Cherneva

The program has so far covered 19 women: 17with fractures of the arm, and two – of the leg.

Six of the patients started rehabilitation while still in plaster. The rest –13 started right a plaster was removed.

Rehabilitation programs were three weeks long, on the average, and the criteria for assessment included: pain, extent of limitation in movement of the affected extremity, level of independence in everyday activities, and ability to work. All patients were referred for rehabilitation by orthopedic surgeons and physiotherapeutists.

The program was realized on the premises of the diagnostic and consulting center, in collaboration with kinesitherapists and physical rehabilitation specialists.

 

 

Computer training for nurses, physiotherapeutists, lab technicians, midwives and feldschers

Mrs. Nelly Todorova

Seventy members of the junior hospital staff of the Regional Hospital in Gabrovo took computer courses.

Admissions to the hospital, codes of diseases and administration of the hospital have been computerized.

Future plans include English language courses, Internet skills, and computerizing the communications between the hospital wards.

 

 

Reducing the rates of spinal deformities in children in Neophit Rilski Middle School  in Gabrovo

Mrs. Petya Toshkova

A pediatrician – Dr. Stefanova, to find which of the children had 1st and 2nd degree of deformities, first examined the children. The rate of spinal deformities in the children was high – over 30%.

These children have remedial gymnastics classes three times a week. Additional costs for teachers were covered by the municipality.

Apart from these classes for children with problems, all children do physical exercises for 15 minutes each time they have physical education classes. These exercises are suitable for children with deformities.

Talks were organized by the school nurse Mrs. Margarita Ganeva on topics to raise the children’s level of knowledge on the problem.

At the beginning of the school year, the children will be examined again to find out if the percentage of those with deformities. .

All the activities are documented. We believe the project will become a long-term program, and help reduce the percentage of children with deformities.

 

 

Anti-smoking program for children aged 8-15 attending Neophit Rilski Middle School in Gabrovo

Mrs. Pepa Yoteva

The children were divided into two groups: the first one included children aged 8-10, and the second – 11-15 year-old.

The initial inquiry was made with a group, representative for the school, to assess the level of knowledge on the dangers of smoking.

An essay writing and a picture drawing competitions took place in the school: “Smoking or health: Choose for yourself”. The children watched and then discussed a film on cigarette smoking.

Role-plays were used with the younger children. With the older ones, there were training sessions on prevention of smoking. Those students were included in discussion groups, and later participated as facilitators in the sessions with the younger children.

On the International Anti-Smoking Day – May 31st, the drawings and the essays were arranged in an exhibition at the National Museum of Education (Aprilov High School).

In June, an inquiry was organized again, and the level of knowledge on smoking assessed again. The average of 85% of the answers were correct.

 

 

Raisin the level of knowledge on the harmful effect of drugs and alcohol in schoolchildren aged 12-14, attending Neophit Rilski Middle School in Gabrovo

Mrs. Maya Koleva

The aim of the project is to raise the children’s level of knowledge by not only providing them with information on the problem, since the ability to resist the pressure by peers and others is not less important.

The inquiry at the beginning provided information what the weak points are. The activities of the pedagogical advisor and the class teachers were interactive, involving all students in talks and discussion. Two films – “I Accuse”and “The Vicious Circle”, both treating the variety problems arising from drug and alcohol use and abuse, were watched and then discussed in a debate with the motto “The Right to Choose”.

A debate was held in April with the students in the seventh grade (aged 14): is drug use an addiction or inability to adapt to reality. The students demonstrated high level of competence and were applauded by their peers and teachers.

In May, the best drawings and essays were displayed at the National Museum of Education. Winners were awarded prizes.

The results from the final inquiry demonstrated that the children had gained from the program.

 

 

Early diagnosis of colorectal cancer

Dr. Todor Shandurkov

Between December 12, 2000 and May 31, 2001, 374 people were examined at the consulting room. These were selected from among the employees of Gabrovo firms. Of them, 127 (43%) were under 60 years of age. Eight patients were diagnosed with colon cancer and referred for treatment.

Future plans include introduction of total colonoscopy.

 

 

Correction of flat foot deformities and incorrect posture in children aged four to ten through dancing lessons

Mr. Tsenislav Vlaknenski

The dancing groups were organized for primary school children attending “Neophit Rilski” School and “Radost” kindergarten in Gabrovo.        The team - a coordinating committee, a kinesithepist and nurses made plantogram examinations for 380 children (aged four to ten). The plantograms showed that 16%of the children aged 4-6, and 23% of the children aged 7-10 had problems.

Six hundred brochures were distributed, and meetings with the parents were organized.

Four dancing groups (45 children) were set up. They have dancing lessons twice a week for one hour.

The final results will be assessed in January 2002.