Peripheral arterial disease: where are we in 2006?

The prevalence of obstructive arterial disease is between 3.5 and 12.1% in 60 aged populations. It's a current disease which has a pernicious influence in quality of life. Management of patients with peripheral arterial occlusive disease has to be planned in the context of natural history, epidemiology, and apparent risk factors that predict deterioration. The purpose of this review is to take stock of the consensus and the controversies about terminology, epidemiology, diagnosis and management of peripheral arterial occlusive disease.     

Leadership in the UK NHS: where are we now?

The introduction of changes to the UK National Health Service from the 1980s onwards, coupled with recognition that successful improvement to health and health services places greater pressure on developing good inter-personal and inter-organisational relationships, underlines the need for greater leadership of health services in the future. Argues that insufficient attention has been paid to the development of external leadership, the growing importance of which is emphasised by the most recent proposals for change to health services from the 1997 Labour government. Comparisons of managerial life between the public and private sectors are made and surveys of NHS managerial work, carried out over a number of years, seem to have produced similar conclusions. Finally a paradigm shift is called for in the leadership of health services in the future if the impact of the external environment is to be managed more effectively and no longer to be seen as a constraint on public sector managerial activity.     

Exposure to environmental tobacco smoke in the workplace in Macedonia: where are we now?

To assess the prevalence and the level of exposure to environmental tobacco smoke (ETS) in the workplace after the enactment of the law restricting indoor smoking in Macedonia, we performed a cross-sectional, self-administered questionnaire study including 372 never-smoking workers recruited from six workplaces. We found a high prevalence of workers exposed to ETS in the workplace (27.4 %) with no significant difference between particular occupation groups. We found no significant difference in the prevalence of passive smokers in the workplace between this study and our study conducted before the law was enacted (31.5 % vs. 27.4 %, P=0.324). The prevalence of workers exposed to ETS for less than three hours a day was significantly lower than of passive smokers with longer exposure (28.4 % vs. 71.6 %, P=0.038). The prevalence of workers exposed to ETS from less than 10 cigarettes smoked by coworkers per day was lower than the prevalence of workers with higher exposure, but statistical significance was not reached (37.9 % vs. 62.1 %, P=0.087). Our findings indicate a high prevalence and a high level of exposure to ETS in the workplace, which calls for stricter adherence to smoking-free legislation or even the total ban of smoking in the workplace.     

Diet and cancer: where are we and where are we going?

Many studies have shown that overall dietary patterns, dietary components consumed, or mode of food preparation are all possibly relevant in either reducing or increasing the risk of cancer in animals or man. Yet, dietary intervention studies, stemming from laboratory and epidemiological observational studies have often failed to demonstrate the anticipated protection against cancer. One possible explanation for the discrepancy between the results of various observational and experimental chemo-prevention studies is the lack of control for biological diversity of the participants of these studies. It is suggested that future epidemiological studies provide evidence stratified by status of major metabolic polymorphisms pertinent to the study subject, and that future intervention studies take these differences into account in the design and analysis phases.     

Family Medicine in South Africa: where are we now and where do we want to be?

Objectives: This paper outlines the development of family medicine in South Africa with special reference to the process leading to the recognition of this discipline as a medical specialty. It also examines the constraints under which the discipline has had to function, considers where the discipline should be, seeks to identify the barriers to its further development and suggests ways in which to overcome these.

Methods: A short review was carried out of the available South African literature to record the advancement of the discipline and the international literature was searched for articles supporting this direction.

Results: The situation in South Africa is complicated by the existence of many doctor groupings claiming to represent the generalist and the perception that family medicine only addresses the needs of middle-class citizens. A flawed consultative process leading up to the present stage has contributed to this perception.

Conclusions: The available literature supports the establishment of family medicine as a speciality. Developments in South Africa, such as raising the status of Family Medicine and creating a compulsory rotation through family medicine as an extended internship and the creation of registrar posts in family medicine will advance the discipline in a positive manner, whilst possibly attempting to resolve the medical migration issues that are presently destroying Sub-Saharan Africa's health services. Eur J Gen Pract 2005;11(3):127–30.     

Statins: where are we now?

Statin therapy reduces the risk of cardiac events by 30% in both primary and secondary prevention. Although fine-tuning of the evidence will occur as more clinical trials report, the challenge is now to implement the evidence to the benefit of patients.     

Condom effectiveness: where are we now?

After performing a review of prospective cohort evaluations, a focussed assessment of the current knowledge base and methodology pertaining to condom effectiveness against sexually transmissible infections, including HIV, was also conducted. Key observations included the point that studies of condom effectiveness are inherently complex and the potential forms of study bias all generally favour the null hypothesis. Perhaps the most challenging obstacle to rigor in these studies lies in determining which events of condom-protected sex occurred before infection as opposed to after infection when, in fact, infection occurs. This problem leads to misclassification bias; however, other sources of misclassification bias are common. Greater attention to the selection of a recall period, improved precision of self-reported measures, and accounting for condom use errors and problems are critical steps that must occur to promote rigor in these studies. Despite multiple shortcomings, prospective studies of condom effectiveness provide a reasonably favourable evaluation. Subsequent studies, however, should be designed to greatly reduce the error variance that predisposes condom effectiveness studies to type 2 errors that mask the potential value of condoms.