Prevention in the elderly: A necessary priority for general practitioners

Prevention is viewed as a key issue for general practice, yet there is a lack of evidence regarding general practitioners’ interventions in both middle-aged and elderly people. This is despite the fact that recommendations and key indicators for monitoring the use of clinical preventive strategies aimed at these groups are available and that both the World Health Organization and European Commission endorse the importance of interventions for healthy and active ageing. This paper draws on two keynote presentations given at the 2015 autumn meeting of the European General Practice Research Network (EGPRN) in Edirne, Turkey (17–20 October 2015). According to the EU2020 strategy, general practitioners should design and implement prevention services and programmes to promote healthy and active ageing. Their primary focus should be on interventions on multimorbid patients, either by improving prescribing and adherence to medical plans or by targeting to fall and frailty prevention and vaccination uptake.     

Thresholds of physical activities necessary for living a self-supporting life in elderly women

BACKGROUND: To decide the minimal levels (thresholds) of physical activities necessary for a self-supporting life using discriminate analysis between community-dwelling elderly individuals and daycare-service-receiving elderly individuals in Japan. METHOD: A total of twenty-six elderly women, including twelve living a self-supporting life and fourteen using a daycare service, were recruited in this study. The parameters examined were physical performance, activities of daily living, exercise capacity. Discriminate analysis was used to determine the thresholds of physical activities needed to live a self-supporting life. RESULTS: Muscle masses, grip strength, lower-extremity muscle force, gait ability and balance function in elderly individuals living a self-supporting life were significant higher than those in elderly individuals using a daycare service. A threshold of physical ability over 75% classifies accurately using the methods of discriminate analysis indicate total body muscle mass, thigh muscle mass, knee extension force, 6 min walking distance (6MD), 10 m obstacle walking time, Activity of daily living (ADL) index and daily steps. CONCLUSIONS: The present study indicates that thresholds of physical activities including gait abilities, muscle force, and muscle mass are very important factors in maintaining a self-supporting life for elderly individuals. Thresholds of physical activities were more effective than standard values of physical activity for elderly individuals using a care service in meeting the goals of rehabilitation.     

全数字医院建设势在必行

在以网络技术和信息技术为主流的当今社会,现代医学科技的迅猛发展和影像学检查的不断增加,各种医疗信息正呈几何数级增长.全数字医院建设,完善PACS/HIS/RIS这一较大工程,是建设全数字医院的趋势.同时,必须根据医院实际,分布实施.     

The implantable cardioverter-defibrillator: sometimes necessary

The implantable cardioverter-defibrillator (ICD) is used in patients who are at risk for ventricular fibrillation after having suffered from a myocardial infarction. Initially, patient selection was limited to survivors of impending sudden death with coronary artery disease. Later, ICD implantation in high-risk coronary artery disease patients was found to lower cardiovascular mortality. More recently, patients with dilated cardiomyopathy and no coronary artery disease are also potential candidates for implantation of an ICD. In the Netherlands, it is expected that there will be 1-2 ICD-users per 10,000 inhabitants. This means that ambulance personnel, general practitioners and doctors in emergency wards will also be confronted with patients who have had one or more shock treatments. Such medical personnel should have knowledge about the function of the ICD, what to do if several shocks have been given and whom to contact in case problems persist.     

医院管理人员职业化的必要性及可行性研究

由于医院管理人员水平与医院科学管理、医疗服务领域进一步扩大开放的需要不相适应 ,医院管理人员职业化有其必要性 ;同时 ,建立职业化医院管理队伍的政策基础、认识基础、体制基础、物质基础、人才基础及国际国内环境基础已基本具备 ,建立职业化医院管理队伍已具有可行性。因此 ,各级卫生行政主管部门应转变观念 ,提高认识 ,加快卫生管理人才的培养 ,建立完善的职业管理者评价体系。     

Is an adaptation of Siri's formula for the calculation of body fat percentage from body density in the elderly necessary?

Using data from the literature on changes in the mineral content, muscle mass and the amount of water in the body during aging, the age-related changes in the chemical composition of the fat-free mass have been calculated. In men the decrease in minerals (bone loss) during aging equals the decrease in protein and water (muscle) in the fat-free mass. As a consequence the chemical composition of the fat-free mass is hardly affected by aging in men. In women, however, the loss of minerals during aging is considerably higher than the decrease in protein and water in the fat-free mass. As a consequence the change in the chemical composition of the fat-free mass in females is remarkable, and therefore in females, the density (kg/l) of the fat-free mass decreases with age. Consequently the body fat percentage calculated from body density with Siri's equation overestimates the real body fat percentage by 2-3 per cent, depending on age. Based on the calculated chemical composition of the fat-free mass at several ages, and its calculated theoretical density, Siri's equation has been adapted. In females but not in men the adapted formulas give a more valid estimate of the body fat percentage calculated from body density compared to Siri's formula.     

The factors necessary to achieve successful penetrating keratoplasty

A statistical study was conducted of 31 penetrating keratoplasties performances over the past 6 years from January 1980 to December 1985, and the factors necessary to achieve successful penetrating keratoplasty are discussed on the basis of the results of the study. The patients were followed up for more than one year after operation. The graft transparency, visual acuity and incidence of corneal rejection were evaluated at one year after operation and the combined surgery with penetrating keratoplasty was also evaluated. The results obtained were as follows: 1) The distinctive feature of the cases with visual acuity of more than 1.0 were that the recipients were younger than 40 years of age and the donors were also less than 50 years at the time of the operation. 2) The patients with vascularized cornea showed a higher incidence of rejection and a lower successful ratio rate than did the avascular corneal patients. The above results indicate that the factors necessary to achieve a successful penetrating keratoplasty are young recipients, young donors and no vascularization of recipient cornea.     

The necessary shift from diagnostic to prognostic research

Background

The objective of the study is to improve general practitioners' diagnoses of adolescent depression. Major depression is ranked fourth in the worldwide disability impact.

Method/Design

Validation of 1) three key questions, 2) SCL-dep6, 3) SCL-10, 4) 9 other SCL questions and 5) WHO-5 in a clinical study among adolescents. The Composite International Diagnostic Interview (CIDI) is to be used as the gold standard interview. The project is a GP multicenter study to be conducted in both Norway and Denmark. Inclusion criteria are age (14–16) and fluency in the Norwegian and Danish language. A number of GPs will be recruited from both countries and at least 162 adolescents will be enrolled in the study from the patient lists of the GPs in each country, giving a total of at least 323 adolescent participants.

Discussion

The proportion of adolescents suffering from depressive disorders also seems to be increasing worldwide. Early interventions are known to reduce this illness. The earlier depression can be identified in adolescents, the greater the advantage. Therefore, we hope to find a suitable questionnaire that could be recommended for GPs.